|
RING RINGLOC LOCKING SZ 27
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 27
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 28
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 28
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RISPERDAL 0.25MG TABLET
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25001334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
RISPERDAL 0.25MG TABLET
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25001334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
IP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
IP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Professional
|
Both
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Ambetter Exchange |
$10.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Multiplan PHCS |
$42.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.22
|
| Rate for Payer: UHCCP Medicaid |
$24.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.94
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
OP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem Medicaid |
$24.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Humana KY Medicaid |
$24.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
OP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem Medicaid |
$24.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Humana KY Medicaid |
$24.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDAL CONST0.5MG 12.5MGINJ
|
Facility
|
IP
|
$1,758.61
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$527.58 |
| Max. Negotiated Rate |
$1,688.27 |
| Rate for Payer: Aetna Commercial |
$1,354.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.72
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna Commercial |
$1,459.65
|
| Rate for Payer: First Health Commercial |
$1,670.68
|
| Rate for Payer: Humana Commercial |
$1,494.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.44
|
| Rate for Payer: PHCS Commercial |
$1,688.27
|
| Rate for Payer: United Healthcare All Payer |
$1,547.58
|
|
|
RISPERDAL CONST0.5MG 12.5MGINJ
|
Facility
|
OP
|
$1,758.61
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$1,688.27 |
| Rate for Payer: Aetna Commercial |
$1,354.13
|
| Rate for Payer: Anthem Medicaid |
$604.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna Commercial |
$1,459.65
|
| Rate for Payer: First Health Commercial |
$1,670.68
|
| Rate for Payer: Humana Commercial |
$1,494.82
|
| Rate for Payer: Humana KY Medicaid |
$604.79
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$610.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.44
|
| Rate for Payer: PHCS Commercial |
$1,688.27
|
| Rate for Payer: United Healthcare All Payer |
$1,547.58
|
|
|
RISPERDAL CONST 0.5MG 37.5MG V
|
Facility
|
OP
|
$5,275.44
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$5,064.42 |
| Rate for Payer: Aetna Commercial |
$4,062.09
|
| Rate for Payer: Anthem Medicaid |
$1,814.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,114.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$2,637.72
|
| Rate for Payer: Cash Price |
$2,637.72
|
| Rate for Payer: Cigna Commercial |
$4,378.62
|
| Rate for Payer: First Health Commercial |
$5,011.67
|
| Rate for Payer: Humana Commercial |
$4,484.12
|
| Rate for Payer: Humana KY Medicaid |
$1,814.22
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,325.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,893.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,956.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,589.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,640.05
|
| Rate for Payer: PHCS Commercial |
$5,064.42
|
| Rate for Payer: United Healthcare All Payer |
$4,642.39
|
|
|
RISPERDAL CONST 0.5MG 37.5MG V
|
Facility
|
IP
|
$5,275.44
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,582.63 |
| Max. Negotiated Rate |
$5,064.42 |
| Rate for Payer: Aetna Commercial |
$4,062.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,114.84
|
| Rate for Payer: Cash Price |
$2,637.72
|
| Rate for Payer: Cigna Commercial |
$4,378.62
|
| Rate for Payer: First Health Commercial |
$5,011.67
|
| Rate for Payer: Humana Commercial |
$4,484.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,325.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,893.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,956.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,589.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,640.05
|
| Rate for Payer: PHCS Commercial |
$5,064.42
|
| Rate for Payer: United Healthcare All Payer |
$4,642.39
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
IP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Professional
|
Both
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Ambetter Exchange |
$10.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Multiplan PHCS |
$42.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.22
|
| Rate for Payer: UHCCP Medicaid |
$24.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.94
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
OP
|
$3,516.83
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$3,376.16 |
| Rate for Payer: Aetna Commercial |
$2,707.96
|
| Rate for Payer: Anthem Medicaid |
$1,209.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,743.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$1,758.41
|
| Rate for Payer: Cash Price |
$1,758.41
|
| Rate for Payer: Cigna Commercial |
$2,918.97
|
| Rate for Payer: First Health Commercial |
$3,340.99
|
| Rate for Payer: Humana Commercial |
$2,989.31
|
| Rate for Payer: Humana KY Medicaid |
$1,209.44
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,595.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,813.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,426.61
|
| Rate for Payer: PHCS Commercial |
$3,376.16
|
| Rate for Payer: United Healthcare All Payer |
$3,094.81
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
IP
|
$3,516.83
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,055.05 |
| Max. Negotiated Rate |
$3,376.16 |
| Rate for Payer: Aetna Commercial |
$2,707.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,743.13
|
| Rate for Payer: Cash Price |
$1,758.41
|
| Rate for Payer: Cigna Commercial |
$2,918.97
|
| Rate for Payer: First Health Commercial |
$3,340.99
|
| Rate for Payer: Humana Commercial |
$2,989.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,595.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,813.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,426.61
|
| Rate for Payer: PHCS Commercial |
$3,376.16
|
| Rate for Payer: United Healthcare All Payer |
$3,094.81
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
OP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem Medicaid |
$24.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Humana KY Medicaid |
$24.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
OP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem Medicaid |
$24.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Humana KY Medicaid |
$24.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
IP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
OP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem Medicaid |
$24.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Humana KY Medicaid |
$24.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
IP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$67.53 |
| Rate for Payer: Aetna Commercial |
$54.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.87
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$58.38
|
| Rate for Payer: First Health Commercial |
$66.82
|
| Rate for Payer: Humana Commercial |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.90
|
| Rate for Payer: Ohio Health Group HMO |
$52.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.53
|
| Rate for Payer: PHCS Commercial |
$67.53
|
| Rate for Payer: United Healthcare All Payer |
$61.90
|
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Professional
|
Both
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Ambetter Exchange |
$10.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Multiplan PHCS |
$42.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.22
|
| Rate for Payer: UHCCP Medicaid |
$24.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.94
|
|
