ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
IP
|
$176.00
|
|
Service Code
|
HCPCS J2800
|
Hospital Charge Code |
636T0059
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$22.88 |
Max. Negotiated Rate |
$168.96 |
Rate for Payer: Aetna Commercial |
$135.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cigna Commercial |
$146.08
|
Rate for Payer: First Health Commercial |
$167.20
|
Rate for Payer: Humana Commercial |
$149.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
Rate for Payer: Ohio Health Group HMO |
$132.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
Rate for Payer: PHCS Commercial |
$168.96
|
Rate for Payer: United Healthcare All Payer |
$154.88
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
OP
|
$176.00
|
|
Service Code
|
HCPCS J2800
|
Hospital Charge Code |
636T0059
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$22.88 |
Max. Negotiated Rate |
$168.96 |
Rate for Payer: Aetna Commercial |
$135.52
|
Rate for Payer: Anthem Medicaid |
$60.53
|
Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cigna Commercial |
$146.08
|
Rate for Payer: First Health Commercial |
$167.20
|
Rate for Payer: Humana Commercial |
$149.60
|
Rate for Payer: Humana KY Medicaid |
$60.53
|
Rate for Payer: Kentucky WC Medicaid |
$61.14
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
Rate for Payer: Molina Healthcare Medicaid |
$61.74
|
Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
Rate for Payer: Ohio Health Group HMO |
$132.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
Rate for Payer: PHCS Commercial |
$168.96
|
Rate for Payer: United Healthcare All Payer |
$154.88
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
IP
|
$176.00
|
|
Service Code
|
HCPCS J2800
|
Hospital Charge Code |
63600059
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$22.88 |
Max. Negotiated Rate |
$168.96 |
Rate for Payer: Aetna Commercial |
$135.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cigna Commercial |
$146.08
|
Rate for Payer: First Health Commercial |
$167.20
|
Rate for Payer: Humana Commercial |
$149.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
Rate for Payer: Ohio Health Group HMO |
$132.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
Rate for Payer: PHCS Commercial |
$168.96
|
Rate for Payer: United Healthcare All Payer |
$154.88
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Professional
|
Both
|
$176.00
|
|
Service Code
|
HCPCS J2800
|
Hospital Charge Code |
63600059
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$9.51 |
Max. Negotiated Rate |
$176.00 |
Rate for Payer: Aetna Commercial |
$9.51
|
Rate for Payer: Buckeye Medicare Advantage |
$176.00
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Healthspan PPO |
$13.90
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.32
|
Rate for Payer: Multiplan PHCS |
$105.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.20
|
Rate for Payer: UHCCP Medicaid |
$61.60
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
OP
|
$176.00
|
|
Service Code
|
HCPCS J2800
|
Hospital Charge Code |
63600059
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$22.88 |
Max. Negotiated Rate |
$168.96 |
Rate for Payer: Aetna Commercial |
$135.52
|
Rate for Payer: Anthem Medicaid |
$60.53
|
Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
Rate for Payer: Cash Price |
$88.00
|
Rate for Payer: Cigna Commercial |
$146.08
|
Rate for Payer: First Health Commercial |
$167.20
|
Rate for Payer: Humana Commercial |
$149.60
|
Rate for Payer: Humana KY Medicaid |
$60.53
|
Rate for Payer: Kentucky WC Medicaid |
$61.14
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
Rate for Payer: Molina Healthcare Medicaid |
$61.74
|
Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
Rate for Payer: Ohio Health Group HMO |
$132.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
Rate for Payer: PHCS Commercial |
$168.96
|
Rate for Payer: United Healthcare All Payer |
$154.88
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
OP
|
$117.00
|
|
Service Code
|
HCPCS J2800
|
Hospital Charge Code |
25002355
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$15.21 |
Max. Negotiated Rate |
$112.32 |
Rate for Payer: Aetna Commercial |
$90.09
|
Rate for Payer: Anthem Medicaid |
$40.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
Rate for Payer: Cash Price |
$58.50
|
Rate for Payer: Cigna Commercial |
$97.11
|
Rate for Payer: First Health Commercial |
$111.15
|
Rate for Payer: Humana Commercial |
$99.45
|
Rate for Payer: Humana KY Medicaid |
$40.24
|
Rate for Payer: Kentucky WC Medicaid |
$40.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
Rate for Payer: Ohio Health Group HMO |
$87.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
Rate for Payer: PHCS Commercial |
$112.32
|
Rate for Payer: United Healthcare All Payer |
$102.96
|
|
ROBAXIN (METHOCARBA 500MG/1TAB
|
Facility
|
OP
|
$4.45
|
|
Service Code
|
NDC 60687055901
|
Hospital Charge Code |
25001337
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$4.27 |
Rate for Payer: Aetna Commercial |
$3.43
|
Rate for Payer: Anthem Medicaid |
$1.53
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
Rate for Payer: Cash Price |
$2.22
|
Rate for Payer: Cigna Commercial |
$3.69
|
Rate for Payer: First Health Commercial |
$4.23
|
Rate for Payer: Humana Commercial |
$3.78
|
Rate for Payer: Humana KY Medicaid |
$1.53
|
Rate for Payer: Kentucky WC Medicaid |
$1.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
Rate for Payer: Ohio Health Group HMO |
$3.34
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
Rate for Payer: PHCS Commercial |
$4.27
|
Rate for Payer: United Healthcare All Payer |
$3.92
|
|
ROBAXIN (METHOCARBA 500MG/1TAB
|
Facility
|
IP
|
$4.45
|
|
Service Code
|
NDC 60687055901
|
Hospital Charge Code |
25001337
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$4.27 |
Rate for Payer: Aetna Commercial |
$3.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
Rate for Payer: Cash Price |
$2.22
|
Rate for Payer: Cigna Commercial |
$3.69
|
Rate for Payer: First Health Commercial |
$4.23
|
Rate for Payer: Humana Commercial |
$3.78
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
Rate for Payer: Ohio Health Group HMO |
$3.34
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
Rate for Payer: PHCS Commercial |
$4.27
|
Rate for Payer: United Healthcare All Payer |
$3.92
|
|
ROBAXIN (METHOCARBA 750MG/1TAB
|
Facility
|
IP
|
$4.26
|
|
Service Code
|
NDC 70010077001
|
Hospital Charge Code |
25001338
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.55 |
Max. Negotiated Rate |
$4.09 |
Rate for Payer: Aetna Commercial |
$3.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
Rate for Payer: Cash Price |
$2.13
|
Rate for Payer: Cigna Commercial |
$3.54
|
Rate for Payer: First Health Commercial |
$4.05
|
Rate for Payer: Humana Commercial |
$3.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
Rate for Payer: Ohio Health Group HMO |
$3.20
|
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 |
$1.32
|
Rate for Payer: PHCS Commercial |
$4.09
|
Rate for Payer: United Healthcare All Payer |
$3.75
|
|
ROBAXIN (METHOCARBA 750MG/1TAB
|
Facility
|
OP
|
$4.26
|
|
Service Code
|
NDC 70010077001
|
Hospital Charge Code |
25001338
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.55 |
Max. Negotiated Rate |
$4.09 |
Rate for Payer: Aetna Commercial |
$3.28
|
Rate for Payer: Anthem Medicaid |
$1.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
Rate for Payer: Cash Price |
$2.13
|
Rate for Payer: Cigna Commercial |
$3.54
|
Rate for Payer: First Health Commercial |
$4.05
|
Rate for Payer: Humana Commercial |
$3.62
|
Rate for Payer: Humana KY Medicaid |
$1.47
|
Rate for Payer: Kentucky WC Medicaid |
$1.48
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
Rate for Payer: Ohio Health Group HMO |
$3.20
|
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 |
$1.32
|
Rate for Payer: PHCS Commercial |
$4.09
|
Rate for Payer: United Healthcare All Payer |
$3.75
|
|
ROBINSON CUPPED PISTON 4.0 LG
|
Facility
|
OP
|
$1,770.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$230.10 |
Max. Negotiated Rate |
$1,699.20 |
Rate for Payer: Aetna Commercial |
$1,362.90
|
Rate for Payer: Anthem Medicaid |
$608.70
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
Rate for Payer: Cash Price |
$885.00
|
Rate for Payer: Cigna Commercial |
$1,469.10
|
Rate for Payer: First Health Commercial |
$1,681.50
|
Rate for Payer: Humana Commercial |
$1,504.50
|
Rate for Payer: Humana KY Medicaid |
$608.70
|
Rate for Payer: Kentucky WC Medicaid |
$614.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
Rate for Payer: PHCS Commercial |
$1,699.20
|
Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
ROBINSON CUPPED PISTON 4.0 LG
|
Facility
|
IP
|
$1,770.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$230.10 |
Max. Negotiated Rate |
$1,699.20 |
Rate for Payer: Aetna Commercial |
$1,362.90
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
Rate for Payer: Cash Price |
$885.00
|
Rate for Payer: Cigna Commercial |
$1,469.10
|
Rate for Payer: First Health Commercial |
$1,681.50
|
Rate for Payer: Humana Commercial |
$1,504.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
Rate for Payer: PHCS Commercial |
$1,699.20
|
Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
ROBINSON CUPPED PISTON 4.5 LG
|
Facility
|
OP
|
$1,777.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$231.01 |
Max. Negotiated Rate |
$1,705.92 |
Rate for Payer: Aetna Commercial |
$1,368.29
|
Rate for Payer: Anthem Medicaid |
$611.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.06
|
Rate for Payer: Cash Price |
$888.50
|
Rate for Payer: Cigna Commercial |
$1,474.91
|
Rate for Payer: First Health Commercial |
$1,688.15
|
Rate for Payer: Humana Commercial |
$1,510.45
|
Rate for Payer: Humana KY Medicaid |
$611.11
|
Rate for Payer: Kentucky WC Medicaid |
$617.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,311.43
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$533.10
|
Rate for Payer: Molina Healthcare Medicaid |
$623.37
|
Rate for Payer: Ohio Health Choice Commercial |
$1,563.76
|
Rate for Payer: Ohio Health Group HMO |
$1,332.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$355.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$231.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.87
|
Rate for Payer: PHCS Commercial |
$1,705.92
|
Rate for Payer: United Healthcare All Payer |
$1,563.76
|
|
ROBINSON CUPPED PISTON 4.5 LG
|
Facility
|
IP
|
$1,777.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$231.01 |
Max. Negotiated Rate |
$1,705.92 |
Rate for Payer: Aetna Commercial |
$1,368.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.06
|
Rate for Payer: Cash Price |
$888.50
|
Rate for Payer: Cigna Commercial |
$1,474.91
|
Rate for Payer: First Health Commercial |
$1,688.15
|
Rate for Payer: Humana Commercial |
$1,510.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,311.43
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$533.10
|
Rate for Payer: Ohio Health Choice Commercial |
$1,563.76
|
Rate for Payer: Ohio Health Group HMO |
$1,332.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$355.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$231.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.87
|
Rate for Payer: PHCS Commercial |
$1,705.92
|
Rate for Payer: United Healthcare All Payer |
$1,563.76
|
|
ROBINUL 1 MG TABLET
|
Facility
|
IP
|
$4.32
|
|
Service Code
|
NDC 23155060601
|
Hospital Charge Code |
25001339
|
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
|
|
ROBINUL 1 MG TABLET
|
Facility
|
OP
|
$4.32
|
|
Service Code
|
NDC 23155060601
|
Hospital Charge Code |
25001339
|
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
|
|
ROBINUL(GLYCOPYRROLAT .4MG/2ML
|
Facility
|
OP
|
$112.20
|
|
Service Code
|
NDC 71288041493
|
Hospital Charge Code |
25003421
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.59 |
Max. Negotiated Rate |
$107.71 |
Rate for Payer: Aetna Commercial |
$86.39
|
Rate for Payer: Anthem Medicaid |
$38.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$87.52
|
Rate for Payer: Cash Price |
$56.10
|
Rate for Payer: Cigna Commercial |
$93.13
|
Rate for Payer: First Health Commercial |
$106.59
|
Rate for Payer: Humana Commercial |
$95.37
|
Rate for Payer: Humana KY Medicaid |
$38.59
|
Rate for Payer: Kentucky WC Medicaid |
$38.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$92.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$33.66
|
Rate for Payer: Molina Healthcare Medicaid |
$39.36
|
Rate for Payer: Ohio Health Choice Commercial |
$98.74
|
Rate for Payer: Ohio Health Group HMO |
$84.15
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.44
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.78
|
Rate for Payer: PHCS Commercial |
$107.71
|
Rate for Payer: United Healthcare All Payer |
$98.74
|
|
ROBINUL(GLYCOPYRROLAT .4MG/2ML
|
Facility
|
IP
|
$112.20
|
|
Service Code
|
NDC 71288041493
|
Hospital Charge Code |
25003421
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.59 |
Max. Negotiated Rate |
$107.71 |
Rate for Payer: Aetna Commercial |
$86.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$87.52
|
Rate for Payer: Cash Price |
$56.10
|
Rate for Payer: Cigna Commercial |
$93.13
|
Rate for Payer: First Health Commercial |
$106.59
|
Rate for Payer: Humana Commercial |
$95.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$92.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$33.66
|
Rate for Payer: Ohio Health Choice Commercial |
$98.74
|
Rate for Payer: Ohio Health Group HMO |
$84.15
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.44
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.78
|
Rate for Payer: PHCS Commercial |
$107.71
|
Rate for Payer: United Healthcare All Payer |
$98.74
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
OP
|
$4.43
|
|
Service Code
|
NDC 904653720
|
Hospital Charge Code |
25001340
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$4.25 |
Rate for Payer: Aetna Commercial |
$3.41
|
Rate for Payer: Anthem Medicaid |
$1.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
Rate for Payer: Cash Price |
$2.21
|
Rate for Payer: Cigna Commercial |
$3.68
|
Rate for Payer: First Health Commercial |
$4.21
|
Rate for Payer: Humana Commercial |
$3.77
|
Rate for Payer: Humana KY Medicaid |
$1.52
|
Rate for Payer: Kentucky WC Medicaid |
$1.54
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
Rate for Payer: Ohio Health Group HMO |
$3.32
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
Rate for Payer: PHCS Commercial |
$4.25
|
Rate for Payer: United Healthcare All Payer |
$3.90
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
IP
|
$4.43
|
|
Service Code
|
NDC 904653720
|
Hospital Charge Code |
25001340
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$4.25 |
Rate for Payer: Aetna Commercial |
$3.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
Rate for Payer: Cash Price |
$2.21
|
Rate for Payer: Cigna Commercial |
$3.68
|
Rate for Payer: First Health Commercial |
$4.21
|
Rate for Payer: Humana Commercial |
$3.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
Rate for Payer: Ohio Health Group HMO |
$3.32
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
Rate for Payer: PHCS Commercial |
$4.25
|
Rate for Payer: United Healthcare All Payer |
$3.90
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
IP
|
$4.40
|
|
Service Code
|
NDC 24385090434
|
Hospital Charge Code |
25001340
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$4.22 |
Rate for Payer: Aetna Commercial |
$3.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
Rate for Payer: Cash Price |
$2.20
|
Rate for Payer: Cigna Commercial |
$3.65
|
Rate for Payer: First Health Commercial |
$4.18
|
Rate for Payer: Humana Commercial |
$3.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
Rate for Payer: Ohio Health Group HMO |
$3.30
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
Rate for Payer: PHCS Commercial |
$4.22
|
Rate for Payer: United Healthcare All Payer |
$3.87
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
OP
|
$4.40
|
|
Service Code
|
NDC 24385090434
|
Hospital Charge Code |
25001340
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.57 |
Max. Negotiated Rate |
$4.22 |
Rate for Payer: Aetna Commercial |
$3.39
|
Rate for Payer: Anthem Medicaid |
$1.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
Rate for Payer: Cash Price |
$2.20
|
Rate for Payer: Cigna Commercial |
$3.65
|
Rate for Payer: First Health Commercial |
$4.18
|
Rate for Payer: Humana Commercial |
$3.74
|
Rate for Payer: Humana KY Medicaid |
$1.51
|
Rate for Payer: Kentucky WC Medicaid |
$1.53
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
Rate for Payer: Ohio Health Group HMO |
$3.30
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
Rate for Payer: PHCS Commercial |
$4.22
|
Rate for Payer: United Healthcare All Payer |
$3.87
|
|
ROBITUSSIN DM(GUAIFEN/DM) 10ML
|
Facility
|
IP
|
$10.31
|
|
Service Code
|
NDC 121127600
|
Hospital Charge Code |
25001341
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.34 |
Max. Negotiated Rate |
$9.90 |
Rate for Payer: Aetna Commercial |
$7.94
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8.04
|
Rate for Payer: Cash Price |
$5.16
|
Rate for Payer: Cigna Commercial |
$8.56
|
Rate for Payer: First Health Commercial |
$9.79
|
Rate for Payer: Humana Commercial |
$8.76
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3.09
|
Rate for Payer: Ohio Health Choice Commercial |
$9.07
|
Rate for Payer: Ohio Health Group HMO |
$7.73
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
Rate for Payer: PHCS Commercial |
$9.90
|
Rate for Payer: United Healthcare All Payer |
$9.07
|
|
ROBITUSSIN DM(GUAIFEN/DM) 10ML
|
Facility
|
OP
|
$10.31
|
|
Service Code
|
NDC 121127600
|
Hospital Charge Code |
25001341
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.34 |
Max. Negotiated Rate |
$9.90 |
Rate for Payer: Aetna Commercial |
$7.94
|
Rate for Payer: Anthem Medicaid |
$3.55
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8.04
|
Rate for Payer: Cash Price |
$5.16
|
Rate for Payer: Cigna Commercial |
$8.56
|
Rate for Payer: First Health Commercial |
$9.79
|
Rate for Payer: Humana Commercial |
$8.76
|
Rate for Payer: Humana KY Medicaid |
$3.55
|
Rate for Payer: Kentucky WC Medicaid |
$3.58
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3.09
|
Rate for Payer: Molina Healthcare Medicaid |
$3.62
|
Rate for Payer: Ohio Health Choice Commercial |
$9.07
|
Rate for Payer: Ohio Health Group HMO |
$7.73
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
Rate for Payer: PHCS Commercial |
$9.90
|
Rate for Payer: United Healthcare All Payer |
$9.07
|
|
ROBITUSSIN(GUAIFENE 200MG/10ML
|
Facility
|
OP
|
$1.69
|
|
Service Code
|
NDC 121148800
|
Hospital Charge Code |
25001343
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.22 |
Max. Negotiated Rate |
$1.62 |
Rate for Payer: Aetna Commercial |
$1.30
|
Rate for Payer: Anthem Medicaid |
$0.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1.32
|
Rate for Payer: Cash Price |
$0.84
|
Rate for Payer: Cigna Commercial |
$1.40
|
Rate for Payer: First Health Commercial |
$1.61
|
Rate for Payer: Humana Commercial |
$1.44
|
Rate for Payer: Humana KY Medicaid |
$0.58
|
Rate for Payer: Kentucky WC Medicaid |
$0.59
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
Rate for Payer: Molina Healthcare Medicaid |
$0.59
|
Rate for Payer: Ohio Health Choice Commercial |
$1.49
|
Rate for Payer: Ohio Health Group HMO |
$1.27
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.34
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.52
|
Rate for Payer: PHCS Commercial |
$1.62
|
Rate for Payer: United Healthcare All Payer |
$1.49
|
|