|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
OP
|
$6,257.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$6,006.72 |
| Rate for Payer: Aetna Commercial |
$4,817.89
|
| Rate for Payer: Anthem Medicaid |
$2,151.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,880.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$5,193.31
|
| Rate for Payer: First Health Commercial |
$5,944.15
|
| Rate for Payer: Humana Commercial |
$5,318.45
|
| Rate for Payer: Humana KY Medicaid |
$2,151.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,173.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,130.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,194.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,506.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,005.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,443.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,317.33
|
| Rate for Payer: PHCS Commercial |
$6,006.72
|
| Rate for Payer: United Healthcare All Payer |
$5,506.16
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 15824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
IP
|
$6,257.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,877.10 |
| Max. Negotiated Rate |
$6,006.72 |
| Rate for Payer: Aetna Commercial |
$4,817.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,880.46
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$5,193.31
|
| Rate for Payer: First Health Commercial |
$5,944.15
|
| Rate for Payer: Humana Commercial |
$5,318.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,130.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,877.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,506.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,005.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,443.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,317.33
|
| Rate for Payer: PHCS Commercial |
$6,006.72
|
| Rate for Payer: United Healthcare All Payer |
$5,506.16
|
|
|
RHYTIDECTOMY; FOREHEAD(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
761P0217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,570.95 |
| Rate for Payer: Aetna Commercial |
$1,570.95
|
| Rate for Payer: Anthem Medicaid |
$504.16
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,478.41
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$504.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.24
|
| Rate for Payer: Molina Healthcare Passport |
$504.16
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.20
|
|
|
RHYTIDECTOMY; FOREHEAD(T
|
Facility
|
OP
|
$4,807.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
761T0217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,653.13 |
| Max. Negotiated Rate |
$4,614.72 |
| Rate for Payer: Aetna Commercial |
$3,701.39
|
| Rate for Payer: Anthem Medicaid |
$1,653.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,989.81
|
| Rate for Payer: First Health Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial |
$4,085.95
|
| Rate for Payer: Humana KY Medicaid |
$1,653.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,669.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,316.83
|
| Rate for Payer: PHCS Commercial |
$4,614.72
|
| Rate for Payer: United Healthcare All Payer |
$4,230.16
|
|
|
RHYTIDECTOMY; FOREHEAD(T
|
Facility
|
IP
|
$4,807.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
761T0217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,442.10 |
| Max. Negotiated Rate |
$4,614.72 |
| Rate for Payer: Aetna Commercial |
$3,701.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.46
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,989.81
|
| Rate for Payer: First Health Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial |
$4,085.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,316.83
|
| Rate for Payer: PHCS Commercial |
$4,614.72
|
| Rate for Payer: United Healthcare All Payer |
$4,230.16
|
|
|
RIABNI 10mg (100mg SDV)
|
Facility
|
OP
|
$3,906.56
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$3,750.30 |
| Rate for Payer: Aetna Commercial |
$3,008.05
|
| Rate for Payer: Anthem Medicaid |
$1,343.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.39
|
| Rate for Payer: Cash Price |
$1,953.28
|
| Rate for Payer: Cash Price |
$1,953.28
|
| Rate for Payer: Cigna Commercial |
$3,242.44
|
| Rate for Payer: First Health Commercial |
$3,711.23
|
| Rate for Payer: Humana Commercial |
$3,320.58
|
| Rate for Payer: Humana KY Medicaid |
$1,343.47
|
| Rate for Payer: Humana Medicare Advantage |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,437.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,929.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,398.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.53
|
| Rate for Payer: PHCS Commercial |
$3,750.30
|
| Rate for Payer: United Healthcare All Payer |
$3,437.77
|
|
|
RIABNI 10mg (100mg SDV)
|
Facility
|
IP
|
$3,906.56
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,171.97 |
| Max. Negotiated Rate |
$3,750.30 |
| Rate for Payer: Aetna Commercial |
$3,008.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.12
|
| Rate for Payer: Cash Price |
$1,953.28
|
| Rate for Payer: Cigna Commercial |
$3,242.44
|
| Rate for Payer: First Health Commercial |
$3,711.23
|
| Rate for Payer: Humana Commercial |
$3,320.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,171.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,437.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,929.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,398.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.53
|
| Rate for Payer: PHCS Commercial |
$3,750.30
|
| Rate for Payer: United Healthcare All Payer |
$3,437.77
|
|
|
RIABNI 10mg (500mg SDV)
|
Facility
|
OP
|
$19,532.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$18,751.49 |
| Rate for Payer: Aetna Commercial |
$15,040.26
|
| Rate for Payer: Anthem Medicaid |
$6,717.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,235.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.39
|
| Rate for Payer: Cash Price |
$9,766.40
|
| Rate for Payer: Cash Price |
$9,766.40
|
| Rate for Payer: Cigna Commercial |
$16,212.22
|
| Rate for Payer: First Health Commercial |
$18,556.16
|
| Rate for Payer: Humana Commercial |
$16,602.88
|
| Rate for Payer: Humana KY Medicaid |
$6,717.33
|
| Rate for Payer: Humana Medicare Advantage |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,785.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,016.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,415.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,852.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,188.86
|
| Rate for Payer: Ohio Health Group HMO |
$14,649.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,626.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,993.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,477.63
|
| Rate for Payer: PHCS Commercial |
$18,751.49
|
| Rate for Payer: United Healthcare All Payer |
$17,188.86
|
|
|
RIABNI 10mg (500mg SDV)
|
Facility
|
IP
|
$19,532.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,859.84 |
| Max. Negotiated Rate |
$18,751.49 |
| Rate for Payer: Aetna Commercial |
$15,040.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,235.58
|
| Rate for Payer: Cash Price |
$9,766.40
|
| Rate for Payer: Cigna Commercial |
$16,212.22
|
| Rate for Payer: First Health Commercial |
$18,556.16
|
| Rate for Payer: Humana Commercial |
$16,602.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,016.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,415.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,859.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,188.86
|
| Rate for Payer: Ohio Health Group HMO |
$14,649.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,626.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,993.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,477.63
|
| Rate for Payer: PHCS Commercial |
$18,751.49
|
| Rate for Payer: United Healthcare All Payer |
$17,188.86
|
|
|
RIATA RV LEAD 65CM
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
RIATA RV LEAD 65CM
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
RIBASPHERE 200MG CAPSULE
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 65862029084
|
| Hospital Charge Code |
25001325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| 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 |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.44
|
| 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 |
$2.80 |
| 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 |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.44
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
RIBOFLAVIN 50MG TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 35046000120
|
| Hospital Charge Code |
25001326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
RIBOFLAVIN 50MG TABLET
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 35046000120
|
| Hospital Charge Code |
25001326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
RIFADIN (RIFAMPIN) 300MG/1CAP
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
NDC 60687058601
|
| Hospital Charge Code |
25001328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| 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 |
$7.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.80
|
| Rate for Payer: PHCS Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Payer |
$8.68
|
|
|
RIFADIN (RIFAMPIN) 300MG/1CAP
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
NDC 60687058601
|
| Hospital Charge Code |
25001328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| 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 |
$7.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.80
|
| Rate for Payer: PHCS Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Payer |
$8.68
|
|
|
RIFAMPIN 150 MG CAPSULE
|
Facility
|
OP
|
$11.19
|
|
|
Service Code
|
NDC 60687057521
|
| Hospital Charge Code |
25004112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| 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 |
$8.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.72
|
| 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 |
$3.36 |
| 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 |
$8.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.72
|
| Rate for Payer: PHCS Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Payer |
$9.85
|
|
|
RIFAMPIN (1MG)600MG/10ML
|
Facility
|
OP
|
$606.56
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
25001329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.97 |
| 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 |
$485.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.53
|
| Rate for Payer: PHCS Commercial |
$582.30
|
| Rate for Payer: United Healthcare All Payer |
$533.77
|
|
|
RIFAMPIN (1MG)600MG/10ML
|
Facility
|
IP
|
$606.56
|
|
|
Service Code
|
HCPCS J2804
|
| Hospital Charge Code |
25001329
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.97 |
| 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 |
$485.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.53
|
| Rate for Payer: PHCS Commercial |
$582.30
|
| Rate for Payer: United Healthcare All Payer |
$533.77
|
|
|
RIGHT ANTEVERTED MOD NECK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
RIGHT ANTEVERTED MOD NECK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
