|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
OP
|
$70.34
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600218
|
|
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 |
636T0218
|
|
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(50mgSyr)
|
Professional
|
Both
|
$64.53
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$38.72 |
| 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 |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| 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 |
$38.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.22
|
| Rate for Payer: UHCCP Medicaid |
$22.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.94
|
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
IP
|
$64.53
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Aetna Commercial |
$49.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cigna Commercial |
$53.56
|
| Rate for Payer: First Health Commercial |
$61.30
|
| Rate for Payer: Humana Commercial |
$54.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
| Rate for Payer: Ohio Health Group HMO |
$48.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.53
|
| Rate for Payer: PHCS Commercial |
$61.95
|
| Rate for Payer: United Healthcare All Payer |
$56.79
|
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
IP
|
$64.53
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Aetna Commercial |
$49.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cigna Commercial |
$53.56
|
| Rate for Payer: First Health Commercial |
$61.30
|
| Rate for Payer: Humana Commercial |
$54.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
| Rate for Payer: Ohio Health Group HMO |
$48.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.53
|
| Rate for Payer: PHCS Commercial |
$61.95
|
| Rate for Payer: United Healthcare All Payer |
$56.79
|
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
OP
|
$64.53
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
636T0224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Aetna Commercial |
$49.69
|
| Rate for Payer: Anthem Medicaid |
$22.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cigna Commercial |
$53.56
|
| Rate for Payer: First Health Commercial |
$61.30
|
| Rate for Payer: Humana Commercial |
$54.85
|
| Rate for Payer: Humana KY Medicaid |
$22.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$22.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
| Rate for Payer: Ohio Health Group HMO |
$48.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.53
|
| Rate for Payer: PHCS Commercial |
$61.95
|
| Rate for Payer: United Healthcare All Payer |
$56.79
|
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
OP
|
$64.53
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$61.95 |
| Rate for Payer: Aetna Commercial |
$49.69
|
| Rate for Payer: Anthem Medicaid |
$22.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cigna Commercial |
$53.56
|
| Rate for Payer: First Health Commercial |
$61.30
|
| Rate for Payer: Humana Commercial |
$54.85
|
| Rate for Payer: Humana KY Medicaid |
$22.19
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$22.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
| Rate for Payer: Ohio Health Group HMO |
$48.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.53
|
| Rate for Payer: PHCS Commercial |
$61.95
|
| Rate for Payer: United Healthcare All Payer |
$56.79
|
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
IP
|
$7,034.15
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25004437
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,110.24 |
| Max. Negotiated Rate |
$6,752.78 |
| Rate for Payer: Aetna Commercial |
$5,416.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.64
|
| Rate for Payer: Cash Price |
$3,517.07
|
| Rate for Payer: Cigna Commercial |
$5,838.34
|
| Rate for Payer: First Health Commercial |
$6,682.44
|
| Rate for Payer: Humana Commercial |
$5,979.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,768.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,110.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,190.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,119.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,853.56
|
| Rate for Payer: PHCS Commercial |
$6,752.78
|
| Rate for Payer: United Healthcare All Payer |
$6,190.05
|
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
OP
|
$7,034.15
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25004437
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$6,752.78 |
| Rate for Payer: Aetna Commercial |
$5,416.30
|
| Rate for Payer: Anthem Medicaid |
$2,419.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,486.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$3,517.07
|
| Rate for Payer: Cash Price |
$3,517.07
|
| Rate for Payer: Cigna Commercial |
$5,838.34
|
| Rate for Payer: First Health Commercial |
$6,682.44
|
| Rate for Payer: Humana Commercial |
$5,979.03
|
| Rate for Payer: Humana KY Medicaid |
$2,419.04
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,443.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,768.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,191.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,467.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,190.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,275.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,627.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,119.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,853.56
|
| Rate for Payer: PHCS Commercial |
$6,752.78
|
| Rate for Payer: United Healthcare All Payer |
$6,190.05
|
|
|
RISPERDAL M (RISPERID) 0.5MG T
|
Facility
|
IP
|
$11.50
|
|
|
Service Code
|
NDC 49884031191
|
| Hospital Charge Code |
25001335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna Commercial |
$9.54
|
| Rate for Payer: First Health Commercial |
$10.93
|
| Rate for Payer: Humana Commercial |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.12
|
| Rate for Payer: Ohio Health Group HMO |
$8.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.93
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
RISPERDAL M (RISPERID) 0.5MG T
|
Facility
|
OP
|
$11.50
|
|
|
Service Code
|
NDC 49884031191
|
| Hospital Charge Code |
25001335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Anthem Medicaid |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna Commercial |
$9.54
|
| Rate for Payer: First Health Commercial |
$10.93
|
| Rate for Payer: Humana Commercial |
$9.78
|
| Rate for Payer: Humana KY Medicaid |
$3.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.12
|
| Rate for Payer: Ohio Health Group HMO |
$8.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.93
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
RISPERDAL (RISPERIDON 1MG/1TAB
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
25001332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
RISPERDAL (RISPERIDON 1MG/1TAB
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
25001332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
RISPERDAL (RISPERIDON 2MG/1TAB
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 68084027301
|
| Hospital Charge Code |
25001333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
RISPERDAL (RISPERIDON 2MG/1TAB
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 68084027301
|
| Hospital Charge Code |
25001333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
RISPERDAL(RISPERIDONE)0.5 MG
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.77
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.17
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Humana Medicare Advantage |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
RISPERDAL(RISPERIDONE)0.5 MG
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
25002349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
RISPERDAL(RISPERIDONE)0.5MGTAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68382011314
|
| Hospital Charge Code |
25001336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
RISPERDAL(RISPERIDONE)0.5MGTAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68382011314
|
| Hospital Charge Code |
25001336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
RITUXAN 100 MG/10 ML INJECTION
|
Facility
|
IP
|
$5,120.38
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,536.11 |
| Max. Negotiated Rate |
$4,915.56 |
| Rate for Payer: Aetna Commercial |
$3,942.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.90
|
| Rate for Payer: Cash Price |
$2,560.19
|
| Rate for Payer: Cigna Commercial |
$4,249.92
|
| Rate for Payer: First Health Commercial |
$4,864.36
|
| Rate for Payer: Humana Commercial |
$4,352.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.06
|
| Rate for Payer: PHCS Commercial |
$4,915.56
|
| Rate for Payer: United Healthcare All Payer |
$4,505.93
|
|
|
RITUXAN 100 MG/10 ML INJECTION
|
Facility
|
OP
|
$5,120.38
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.93 |
| Max. Negotiated Rate |
$4,915.56 |
| Rate for Payer: Aetna Commercial |
$3,942.69
|
| Rate for Payer: Anthem Medicaid |
$1,760.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$75.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$106.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.51
|
| Rate for Payer: Cash Price |
$2,560.19
|
| Rate for Payer: Cash Price |
$2,560.19
|
| Rate for Payer: Cigna Commercial |
$4,249.92
|
| Rate for Payer: First Health Commercial |
$4,864.36
|
| Rate for Payer: Humana Commercial |
$4,352.32
|
| Rate for Payer: Humana KY Medicaid |
$1,760.90
|
| Rate for Payer: Humana Medicare Advantage |
$75.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.06
|
| Rate for Payer: PHCS Commercial |
$4,915.56
|
| Rate for Payer: United Healthcare All Payer |
$4,505.93
|
|
|
RITUXAN 100MG [500MG VIAL]
|
Facility
|
IP
|
$25,601.92
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,680.58 |
| Max. Negotiated Rate |
$24,577.84 |
| Rate for Payer: Aetna Commercial |
$19,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.50
|
| Rate for Payer: Cash Price |
$12,800.96
|
| Rate for Payer: Cigna Commercial |
$21,249.59
|
| Rate for Payer: First Health Commercial |
$24,321.82
|
| Rate for Payer: Humana Commercial |
$21,761.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,894.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,481.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,273.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,665.32
|
| Rate for Payer: PHCS Commercial |
$24,577.84
|
| Rate for Payer: United Healthcare All Payer |
$22,529.69
|
|
|
RITUXAN 100MG [500MG VIAL]
|
Facility
|
OP
|
$25,601.92
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
25002677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.93 |
| Max. Negotiated Rate |
$24,577.84 |
| Rate for Payer: Aetna Commercial |
$19,713.48
|
| Rate for Payer: Anthem Medicaid |
$8,804.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$75.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$106.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.51
|
| Rate for Payer: Cash Price |
$12,800.96
|
| Rate for Payer: Cash Price |
$12,800.96
|
| Rate for Payer: Cigna Commercial |
$21,249.59
|
| Rate for Payer: First Health Commercial |
$24,321.82
|
| Rate for Payer: Humana Commercial |
$21,761.63
|
| Rate for Payer: Humana KY Medicaid |
$8,804.50
|
| Rate for Payer: Humana Medicare Advantage |
$75.93
|
| Rate for Payer: Kentucky WC Medicaid |
$8,894.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,894.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,981.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.69
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,481.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,273.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,665.32
|
| Rate for Payer: PHCS Commercial |
$24,577.84
|
| Rate for Payer: United Healthcare All Payer |
$22,529.69
|
|
|
RIV3 VACCINE NO PRESERV IM
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
77000027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
RIV3 VACCINE NO PRESERV IM
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
77000027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
