|
ROBITUSSIN(GUAIFENE 200MG/10ML
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
ROCALTROL(CALCITRI .25MCG/1CAP
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
25001344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.85
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna Commercial |
$4.10
|
| Rate for Payer: First Health Commercial |
$4.69
|
| Rate for Payer: Humana Commercial |
$4.20
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.35
|
| Rate for Payer: Ohio Health Group HMO |
$3.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Payer |
$4.35
|
|
|
ROCALTROL(CALCITRI .25MCG/1CAP
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
25001344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.85
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna Commercial |
$4.10
|
| Rate for Payer: First Health Commercial |
$4.69
|
| Rate for Payer: Humana Commercial |
$4.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.35
|
| Rate for Payer: Ohio Health Group HMO |
$3.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Payer |
$4.35
|
|
|
ROCEPHIN 250 MG(1GM/10ML)
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Humana KY Medicaid |
$26.66
|
| Rate for Payer: Kentucky WC Medicaid |
$26.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.03
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250 MG(1GM/10ML)
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.03
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250 MG[2GM] EQUIV VIA
|
Facility
|
OP
|
$78.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Anthem Medicaid |
$27.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.53
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$65.48
|
| Rate for Payer: First Health Commercial |
$74.95
|
| Rate for Payer: Humana Commercial |
$67.06
|
| Rate for Payer: Humana KY Medicaid |
$27.13
|
| Rate for Payer: Kentucky WC Medicaid |
$27.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.42
|
| Rate for Payer: Ohio Health Group HMO |
$59.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.46
|
| Rate for Payer: PHCS Commercial |
$75.73
|
| Rate for Payer: United Healthcare All Payer |
$69.42
|
|
|
ROCEPHIN 250 MG[2GM] EQUIV VIA
|
Facility
|
IP
|
$78.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.53
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$65.48
|
| Rate for Payer: First Health Commercial |
$74.95
|
| Rate for Payer: Humana Commercial |
$67.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.42
|
| Rate for Payer: Ohio Health Group HMO |
$59.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.46
|
| Rate for Payer: PHCS Commercial |
$75.73
|
| Rate for Payer: United Healthcare All Payer |
$69.42
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
OP
|
$63.97
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.41 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Anthem Medicaid |
$22.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.90
|
| Rate for Payer: Cash Price |
$31.98
|
| Rate for Payer: Cigna Commercial |
$53.10
|
| Rate for Payer: First Health Commercial |
$60.77
|
| Rate for Payer: Humana Commercial |
$54.37
|
| Rate for Payer: Humana KY Medicaid |
$22.00
|
| Rate for Payer: Kentucky WC Medicaid |
$22.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.29
|
| Rate for Payer: Ohio Health Group HMO |
$47.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.83
|
| Rate for Payer: PHCS Commercial |
$61.41
|
| Rate for Payer: United Healthcare All Payer |
$56.29
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Professional
|
Both
|
$30.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$30.49 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.49
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Healthspan PPO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.77
|
| Rate for Payer: Multiplan PHCS |
$18.29
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.34
|
| Rate for Payer: UHCCP Medicaid |
$10.67
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
OP
|
$30.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem Medicaid |
$10.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.78
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cigna Commercial |
$25.31
|
| Rate for Payer: First Health Commercial |
$28.97
|
| Rate for Payer: Humana Commercial |
$25.92
|
| Rate for Payer: Humana KY Medicaid |
$10.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.83
|
| Rate for Payer: Ohio Health Group HMO |
$22.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.45
|
| Rate for Payer: PHCS Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Payer |
$26.83
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
OP
|
$30.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem Medicaid |
$10.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.78
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cigna Commercial |
$25.31
|
| Rate for Payer: First Health Commercial |
$28.97
|
| Rate for Payer: Humana Commercial |
$25.92
|
| Rate for Payer: Humana KY Medicaid |
$10.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.83
|
| Rate for Payer: Ohio Health Group HMO |
$22.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.45
|
| Rate for Payer: PHCS Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Payer |
$26.83
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
IP
|
$30.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.78
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cigna Commercial |
$25.31
|
| Rate for Payer: First Health Commercial |
$28.97
|
| Rate for Payer: Humana Commercial |
$25.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.83
|
| Rate for Payer: Ohio Health Group HMO |
$22.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.45
|
| Rate for Payer: PHCS Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Payer |
$26.83
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
IP
|
$63.97
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.41 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.90
|
| Rate for Payer: Cash Price |
$31.98
|
| Rate for Payer: Cigna Commercial |
$53.10
|
| Rate for Payer: First Health Commercial |
$60.77
|
| Rate for Payer: Humana Commercial |
$54.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.29
|
| Rate for Payer: Ohio Health Group HMO |
$47.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.83
|
| Rate for Payer: PHCS Commercial |
$61.41
|
| Rate for Payer: United Healthcare All Payer |
$56.29
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
IP
|
$30.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.78
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cigna Commercial |
$25.31
|
| Rate for Payer: First Health Commercial |
$28.97
|
| Rate for Payer: Humana Commercial |
$25.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.83
|
| Rate for Payer: Ohio Health Group HMO |
$22.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.45
|
| Rate for Payer: PHCS Commercial |
$29.27
|
| Rate for Payer: United Healthcare All Payer |
$26.83
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem Medicaid |
$6.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.53
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cigna Commercial |
$15.46
|
| Rate for Payer: First Health Commercial |
$17.70
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Humana KY Medicaid |
$6.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.39
|
| Rate for Payer: Ohio Health Group HMO |
$13.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.78
|
| Rate for Payer: PHCS Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Payer |
$16.39
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem Medicaid |
$6.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.53
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cigna Commercial |
$15.46
|
| Rate for Payer: First Health Commercial |
$17.70
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Humana KY Medicaid |
$6.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.39
|
| Rate for Payer: Ohio Health Group HMO |
$13.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.78
|
| Rate for Payer: PHCS Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Payer |
$16.39
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
IP
|
$18.63
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.53
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cigna Commercial |
$15.46
|
| Rate for Payer: First Health Commercial |
$17.70
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.39
|
| Rate for Payer: Ohio Health Group HMO |
$13.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.78
|
| Rate for Payer: PHCS Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Payer |
$16.39
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
IP
|
$18.63
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.53
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cigna Commercial |
$15.46
|
| Rate for Payer: First Health Commercial |
$17.70
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.39
|
| Rate for Payer: Ohio Health Group HMO |
$13.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.78
|
| Rate for Payer: PHCS Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Payer |
$16.39
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Professional
|
Both
|
$18.63
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.63
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Cash Price |
$9.31
|
| Rate for Payer: Healthspan PPO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.77
|
| Rate for Payer: Multiplan PHCS |
$11.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.04
|
| Rate for Payer: UHCCP Medicaid |
$6.52
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Humana KY Medicaid |
$26.66
|
| Rate for Payer: Kentucky WC Medicaid |
$26.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.03
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.03
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN (CEFTRIAXON 250MG/1ML
|
Facility
|
IP
|
$77.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.60
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna Commercial |
$64.48
|
| Rate for Payer: First Health Commercial |
$73.81
|
| Rate for Payer: Humana Commercial |
$66.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.37
|
| Rate for Payer: Ohio Health Group HMO |
$58.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.08
|
| Rate for Payer: PHCS Commercial |
$74.58
|
| Rate for Payer: United Healthcare All Payer |
$68.37
|
|
|
ROCEPHIN (CEFTRIAXON 250MG/1ML
|
Facility
|
OP
|
$77.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Anthem Medicaid |
$26.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.60
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna Commercial |
$64.48
|
| Rate for Payer: First Health Commercial |
$73.81
|
| Rate for Payer: Humana Commercial |
$66.04
|
| Rate for Payer: Humana KY Medicaid |
$26.72
|
| Rate for Payer: Kentucky WC Medicaid |
$26.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.37
|
| Rate for Payer: Ohio Health Group HMO |
$58.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.08
|
| Rate for Payer: PHCS Commercial |
$74.58
|
| Rate for Payer: United Healthcare All Payer |
$68.37
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem Medicaid |
$26.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Humana KY Medicaid |
$26.62
|
| Rate for Payer: Kentucky WC Medicaid |
$26.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.99
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
IP
|
$74.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna Commercial |
$57.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.26
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cigna Commercial |
$61.99
|
| Rate for Payer: First Health Commercial |
$70.96
|
| Rate for Payer: Humana Commercial |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.73
|
| Rate for Payer: Ohio Health Group HMO |
$56.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.15
|
| Rate for Payer: PHCS Commercial |
$71.70
|
| Rate for Payer: United Healthcare All Payer |
$65.73
|
|
