|
RISPERDAL M (RISPERID) 0.5MG T
|
Facility
|
OP
|
$11.50
|
|
|
Service Code
|
NDC 49884031191
|
| Hospital Charge Code |
25001335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Anthem Medicaid |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna Commercial |
$9.54
|
| Rate for Payer: First Health Commercial |
$10.92
|
| Rate for Payer: Humana Commercial |
$9.78
|
| Rate for Payer: Humana KY Medicaid |
$3.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.12
|
| Rate for Payer: Ohio Health Group HMO |
$8.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.56
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
RISPERDAL M (RISPERID) 0.5MG T
|
Facility
|
IP
|
$11.50
|
|
|
Service Code
|
NDC 49884031191
|
| Hospital Charge Code |
25001335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna Commercial |
$9.54
|
| Rate for Payer: First Health Commercial |
$10.92
|
| Rate for Payer: Humana Commercial |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.12
|
| Rate for Payer: Ohio Health Group HMO |
$8.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.56
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
RISPERDAL (RISPERIDON 1MG/1TAB
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
25001332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
RISPERDAL (RISPERIDON 1MG/1TAB
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
25001332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
RISPERDAL (RISPERIDON 2MG/1TAB
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 68084027301
|
| Hospital Charge Code |
25001333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
RISPERDAL (RISPERIDON 2MG/1TAB
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 68084027301
|
| Hospital Charge Code |
25001333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
RISPERDAL(RISPERIDONE)0.5 MG
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
RISPERDAL(RISPERIDONE)0.5 MG
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Humana Medicare Advantage |
$12.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
RISPERDAL(RISPERIDONE)0.5MGTAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68382011314
|
| Hospital Charge Code |
25001336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
RISPERDAL(RISPERIDONE)0.5MGTAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68382011314
|
| Hospital Charge Code |
25001336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
RITUXAN 100 MG/10 ML INJECTION
|
Facility
|
IP
|
$5,120.38
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.56 |
| Rate for Payer: Aetna Commercial |
$3,942.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.90
|
| Rate for Payer: Cash Price |
$2,560.19
|
| Rate for Payer: Cigna Commercial |
$4,249.92
|
| Rate for Payer: First Health Commercial |
$4,864.36
|
| Rate for Payer: Humana Commercial |
$4,352.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.56
|
| Rate for Payer: United Healthcare All Payer |
$4,505.93
|
|
|
RITUXAN 100 MG/10 ML INJECTION
|
Facility
|
OP
|
$5,120.38
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$4,915.56 |
| Rate for Payer: Aetna Commercial |
$3,942.69
|
| Rate for Payer: Anthem Medicaid |
$1,760.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$79.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.92
|
| Rate for Payer: Cash Price |
$2,560.19
|
| Rate for Payer: Cash Price |
$2,560.19
|
| Rate for Payer: Cigna Commercial |
$4,249.92
|
| Rate for Payer: First Health Commercial |
$4,864.36
|
| Rate for Payer: Humana Commercial |
$4,352.32
|
| Rate for Payer: Humana KY Medicaid |
$1,760.90
|
| Rate for Payer: Humana Medicare Advantage |
$79.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.56
|
| Rate for Payer: United Healthcare All Payer |
$4,505.93
|
|
|
RITUXAN 100MG [500MG VIAL]
|
Facility
|
OP
|
$25,601.92
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$24,577.84 |
| Rate for Payer: Aetna Commercial |
$19,713.48
|
| Rate for Payer: Anthem Medicaid |
$8,804.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$79.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.92
|
| Rate for Payer: Cash Price |
$12,800.96
|
| Rate for Payer: Cash Price |
$12,800.96
|
| Rate for Payer: Cigna Commercial |
$21,249.59
|
| Rate for Payer: First Health Commercial |
$24,321.82
|
| Rate for Payer: Humana Commercial |
$21,761.63
|
| Rate for Payer: Humana KY Medicaid |
$8,804.50
|
| Rate for Payer: Humana Medicare Advantage |
$79.20
|
| Rate for Payer: Kentucky WC Medicaid |
$8,894.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,894.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,981.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.60
|
| Rate for Payer: PHCS Commercial |
$24,577.84
|
| Rate for Payer: United Healthcare All Payer |
$22,529.69
|
|
|
RITUXAN 100MG [500MG VIAL]
|
Facility
|
IP
|
$25,601.92
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,328.25 |
| Max. Negotiated Rate |
$24,577.84 |
| Rate for Payer: Aetna Commercial |
$19,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.50
|
| Rate for Payer: Cash Price |
$12,800.96
|
| Rate for Payer: Cigna Commercial |
$21,249.59
|
| Rate for Payer: First Health Commercial |
$24,321.82
|
| Rate for Payer: Humana Commercial |
$21,761.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,894.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.60
|
| Rate for Payer: PHCS Commercial |
$24,577.84
|
| Rate for Payer: United Healthcare All Payer |
$22,529.69
|
|
|
RIV3 VACCINE NO PRESERV IM
|
Facility
|
OP
|
$117.08
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
77000027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$112.40 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: Anthem Medicaid |
$40.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.32
|
| Rate for Payer: Cash Price |
$58.54
|
| Rate for Payer: Cigna Commercial |
$97.18
|
| Rate for Payer: First Health Commercial |
$111.23
|
| Rate for Payer: Humana Commercial |
$99.52
|
| Rate for Payer: Humana KY Medicaid |
$40.26
|
| Rate for Payer: Kentucky WC Medicaid |
$40.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.03
|
| Rate for Payer: Ohio Health Group HMO |
$87.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.29
|
| Rate for Payer: PHCS Commercial |
$112.40
|
| Rate for Payer: United Healthcare All Payer |
$103.03
|
|
|
RIV3 VACCINE NO PRESERV IM
|
Professional
|
Both
|
$117.08
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
77000027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$117.08 |
| Rate for Payer: Buckeye Medicare Advantage |
$117.08
|
| Rate for Payer: Cash Price |
$58.54
|
| Rate for Payer: Cash Price |
$58.54
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.60
|
| Rate for Payer: Multiplan PHCS |
$70.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.96
|
| Rate for Payer: UHCCP Medicaid |
$40.98
|
|
|
RIV3 VACCINE NO PRESERV IM
|
Facility
|
IP
|
$117.08
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
77000027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$112.40 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.32
|
| Rate for Payer: Cash Price |
$58.54
|
| Rate for Payer: Cigna Commercial |
$97.18
|
| Rate for Payer: First Health Commercial |
$111.23
|
| Rate for Payer: Humana Commercial |
$99.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.03
|
| Rate for Payer: Ohio Health Group HMO |
$87.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.29
|
| Rate for Payer: PHCS Commercial |
$112.40
|
| Rate for Payer: United Healthcare All Payer |
$103.03
|
|
|
RIV3 VACCINE NO PRESERV IM(T
|
Facility
|
OP
|
$117.08
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
770T0027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$112.40 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: Anthem Medicaid |
$40.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.32
|
| Rate for Payer: Cash Price |
$58.54
|
| Rate for Payer: Cigna Commercial |
$97.18
|
| Rate for Payer: First Health Commercial |
$111.23
|
| Rate for Payer: Humana Commercial |
$99.52
|
| Rate for Payer: Humana KY Medicaid |
$40.26
|
| Rate for Payer: Kentucky WC Medicaid |
$40.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.03
|
| Rate for Payer: Ohio Health Group HMO |
$87.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.29
|
| Rate for Payer: PHCS Commercial |
$112.40
|
| Rate for Payer: United Healthcare All Payer |
$103.03
|
|
|
RIV3 VACCINE NO PRESERV IM(T
|
Facility
|
IP
|
$117.08
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
770T0027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$112.40 |
| Rate for Payer: Aetna Commercial |
$90.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.32
|
| Rate for Payer: Cash Price |
$58.54
|
| Rate for Payer: Cigna Commercial |
$97.18
|
| Rate for Payer: First Health Commercial |
$111.23
|
| Rate for Payer: Humana Commercial |
$99.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.03
|
| Rate for Payer: Ohio Health Group HMO |
$87.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.29
|
| Rate for Payer: PHCS Commercial |
$112.40
|
| Rate for Payer: United Healthcare All Payer |
$103.03
|
|
|
RIV4 VACC RECOMBINANT DNA IM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
77000031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIV4 VACC RECOMBINANT DNA IM
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
77000031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
|
|
RIV4 VACC RECOMBINANT DNA IM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
77000031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIV4 VACC RECOMBINANT DNA I(T
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
770T0031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIV4 VACC RECOMBINANT DNA I(T
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
770T0031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIVACOR 7 VR-T DF4 PRO MRI
|
Facility
|
IP
|
$35,788.50
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,652.50 |
| Max. Negotiated Rate |
$34,356.96 |
| Rate for Payer: Aetna Commercial |
$27,557.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,915.03
|
| Rate for Payer: Cash Price |
$17,894.25
|
| Rate for Payer: Cigna Commercial |
$29,704.46
|
| Rate for Payer: First Health Commercial |
$33,999.08
|
| Rate for Payer: Humana Commercial |
$30,420.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,346.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,411.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,736.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,493.88
|
| Rate for Payer: Ohio Health Group HMO |
$26,841.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,157.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,094.44
|
| Rate for Payer: PHCS Commercial |
$34,356.96
|
| Rate for Payer: United Healthcare All Payer |
$31,493.88
|
|
