|
RIATA RV LEAD 65CM
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
RIATA RV LEAD 65CM
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
RIBASPHERE 200MG CAPSULE
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 65862029084
|
| Hospital Charge Code |
25001325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.86
|
| Rate for Payer: Humana Commercial |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.21
|
| Rate for Payer: Ohio Health Group HMO |
$7.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.89
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
RIBASPHERE 200MG CAPSULE
|
Facility
|
OP
|
$9.33
|
|
|
Service Code
|
NDC 65862029084
|
| Hospital Charge Code |
25001325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem Medicaid |
$3.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.86
|
| Rate for Payer: Humana Commercial |
$7.93
|
| Rate for Payer: Humana KY Medicaid |
$3.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.21
|
| Rate for Payer: Ohio Health Group HMO |
$7.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.89
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
RIBOFLAVIN 50MG TABLET
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 35046000120
|
| Hospital Charge Code |
25001326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
RIBOFLAVIN 50MG TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 35046000120
|
| Hospital Charge Code |
25001326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
RIFADIN (RIFAMPIN) 300MG/1CAP
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
NDC 60687058601
|
| Hospital Charge Code |
25001328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$7.59
|
| Rate for Payer: Anthem Medicaid |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.69
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: First Health Commercial |
$9.37
|
| Rate for Payer: Humana Commercial |
$8.38
|
| Rate for Payer: Humana KY Medicaid |
$3.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.68
|
| Rate for Payer: Ohio Health Group HMO |
$7.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Payer |
$8.68
|
|
|
RIFADIN (RIFAMPIN) 300MG/1CAP
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
NDC 60687058601
|
| Hospital Charge Code |
25001328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$7.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.69
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: First Health Commercial |
$9.37
|
| Rate for Payer: Humana Commercial |
$8.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.68
|
| Rate for Payer: Ohio Health Group HMO |
$7.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Payer |
$8.68
|
|
|
RIFADIN (RIFAMPIN) 600MG/10ML
|
Facility
|
IP
|
$606.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Aetna Commercial |
$467.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$473.12
|
| Rate for Payer: Cash Price |
$303.28
|
| Rate for Payer: Cigna Commercial |
$503.44
|
| Rate for Payer: First Health Commercial |
$576.23
|
| Rate for Payer: Humana Commercial |
$515.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$533.77
|
| Rate for Payer: Ohio Health Group HMO |
$454.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.03
|
| Rate for Payer: PHCS Commercial |
$582.30
|
| Rate for Payer: United Healthcare All Payer |
$533.77
|
|
|
RIFADIN (RIFAMPIN) 600MG/10ML
|
Facility
|
OP
|
$606.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Aetna Commercial |
$467.05
|
| Rate for Payer: Anthem Medicaid |
$208.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$473.12
|
| Rate for Payer: Cash Price |
$303.28
|
| Rate for Payer: Cigna Commercial |
$503.44
|
| Rate for Payer: First Health Commercial |
$576.23
|
| Rate for Payer: Humana Commercial |
$515.58
|
| Rate for Payer: Humana KY Medicaid |
$208.60
|
| Rate for Payer: Kentucky WC Medicaid |
$210.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$497.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$212.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$533.77
|
| Rate for Payer: Ohio Health Group HMO |
$454.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.03
|
| Rate for Payer: PHCS Commercial |
$582.30
|
| Rate for Payer: United Healthcare All Payer |
$533.77
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
OP
|
$11.19
|
|
|
Service Code
|
NDC 60687057521
|
| Hospital Charge Code |
25004112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Anthem Medicaid |
$3.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.73
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna Commercial |
$9.29
|
| Rate for Payer: First Health Commercial |
$10.63
|
| Rate for Payer: Humana Commercial |
$9.51
|
| Rate for Payer: Humana KY Medicaid |
$3.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.85
|
| Rate for Payer: Ohio Health Group HMO |
$8.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Payer |
$9.85
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
IP
|
$11.19
|
|
|
Service Code
|
NDC 60687057521
|
| Hospital Charge Code |
25004112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.73
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna Commercial |
$9.29
|
| Rate for Payer: First Health Commercial |
$10.63
|
| Rate for Payer: Humana Commercial |
$9.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.85
|
| Rate for Payer: Ohio Health Group HMO |
$8.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Payer |
$9.85
|
|
|
RIGHT ANTEVERTED MOD NECK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RIGHT ANTEVERTED MOD NECK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RIGHT HEART CATH
|
Facility
|
IP
|
$11,852.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
76102475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,540.76 |
| Max. Negotiated Rate |
$11,377.92 |
| Rate for Payer: Aetna Commercial |
$9,126.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,244.56
|
| Rate for Payer: Cash Price |
$5,926.00
|
| Rate for Payer: Cigna Commercial |
$9,837.16
|
| Rate for Payer: First Health Commercial |
$11,259.40
|
| Rate for Payer: Humana Commercial |
$10,074.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,718.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,746.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,555.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,429.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,889.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,370.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,674.12
|
| Rate for Payer: PHCS Commercial |
$11,377.92
|
| Rate for Payer: United Healthcare All Payer |
$10,429.76
|
|
|
RIGHT HEART CATH
|
Professional
|
Both
|
$11,852.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
76102475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.18 |
| Max. Negotiated Rate |
$11,852.00 |
| Rate for Payer: Aetna Commercial |
$1,189.33
|
| Rate for Payer: Anthem Medicaid |
$666.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,852.00
|
| Rate for Payer: Cash Price |
$5,926.00
|
| Rate for Payer: Cash Price |
$5,926.00
|
| Rate for Payer: Cigna Commercial |
$1,304.97
|
| Rate for Payer: Healthspan PPO |
$883.92
|
| Rate for Payer: Humana Medicaid |
$666.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$680.01
|
| Rate for Payer: Molina Healthcare Passport |
$666.68
|
| Rate for Payer: Multiplan PHCS |
$7,111.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,296.40
|
| Rate for Payer: UHCCP Medicaid |
$4,148.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$673.35
|
|
|
RIGHT HEART CATH
|
Facility
|
OP
|
$11,852.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
76102475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,540.76 |
| Max. Negotiated Rate |
$11,377.92 |
| Rate for Payer: Aetna Commercial |
$9,126.04
|
| Rate for Payer: Anthem Medicaid |
$4,075.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,244.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$5,926.00
|
| Rate for Payer: Cash Price |
$5,926.00
|
| Rate for Payer: Cigna Commercial |
$9,837.16
|
| Rate for Payer: First Health Commercial |
$11,259.40
|
| Rate for Payer: Humana Commercial |
$10,074.20
|
| Rate for Payer: Humana KY Medicaid |
$4,075.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,117.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,718.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,746.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,157.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,429.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,889.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,370.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,674.12
|
| Rate for Payer: PHCS Commercial |
$11,377.92
|
| Rate for Payer: United Healthcare All Payer |
$10,429.76
|
|
|
RIGHT HEART CATH
|
Facility
|
IP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
48100062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
RIGHT HEART CATH
|
Facility
|
OP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
48100062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem Medicaid |
$3,955.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Humana KY Medicaid |
$3,955.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,995.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,034.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
RIGHT HEART CATH(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
761P2475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$1,304.97 |
| Rate for Payer: Aetna Commercial |
$1,189.33
|
| Rate for Payer: Anthem Medicaid |
$666.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$1,304.97
|
| Rate for Payer: Healthspan PPO |
$883.92
|
| Rate for Payer: Humana Medicaid |
$666.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$680.01
|
| Rate for Payer: Molina Healthcare Passport |
$666.68
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$673.35
|
|
|
RIGHT HEART CATH(T
|
Facility
|
IP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
761T2475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
RIGHT HEART CATH(T
|
Facility
|
OP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93451
|
| Hospital Charge Code |
761T2475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem Medicaid |
$3,955.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Humana KY Medicaid |
$3,955.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,995.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,034.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
RILUTEK (RILUZOLE)50MG TAB
|
Facility
|
IP
|
$9.32
|
|
|
Service Code
|
NDC 68462038160
|
| Hospital Charge Code |
25001330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.85
|
| Rate for Payer: Humana Commercial |
$7.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.20
|
| Rate for Payer: Ohio Health Group HMO |
$6.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.89
|
| Rate for Payer: PHCS Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Payer |
$8.20
|
|
|
RILUTEK (RILUZOLE)50MG TAB
|
Facility
|
OP
|
$9.32
|
|
|
Service Code
|
NDC 68462038160
|
| Hospital Charge Code |
25001330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem Medicaid |
$3.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.85
|
| Rate for Payer: Humana Commercial |
$7.92
|
| Rate for Payer: Humana KY Medicaid |
$3.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.20
|
| Rate for Payer: Ohio Health Group HMO |
$6.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.89
|
| Rate for Payer: PHCS Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Payer |
$8.20
|
|
|
RIMSO(DIMETHYLSULF)50% SOL50ML
|
Facility
|
OP
|
$3,247.60
|
|
|
Service Code
|
HCPCS J1212
|
| Hospital Charge Code |
63600032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$422.19 |
| Max. Negotiated Rate |
$3,117.70 |
| Rate for Payer: Aetna Commercial |
$2,500.65
|
| Rate for Payer: Anthem Medicaid |
$1,116.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$680.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$953.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$919.11
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cash Price |
$1,623.80
|
| Rate for Payer: Cigna Commercial |
$2,695.51
|
| Rate for Payer: First Health Commercial |
$3,085.22
|
| Rate for Payer: Humana Commercial |
$2,760.46
|
| Rate for Payer: Humana KY Medicaid |
$1,116.85
|
| Rate for Payer: Humana Medicare Advantage |
$680.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.76
|
| Rate for Payer: PHCS Commercial |
$3,117.70
|
| Rate for Payer: United Healthcare All Payer |
$2,857.89
|
|
