|
RMVL RUPTURED BREAST IMPLANT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
76100310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.30 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
RMVL RUPTURED BREAST IMPLANT(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
761P0310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.98 |
| Max. Negotiated Rate |
$906.93 |
| Rate for Payer: Aetna Commercial |
$906.93
|
| Rate for Payer: Ambetter Exchange |
$611.66
|
| Rate for Payer: Anthem Medicaid |
$332.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$611.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$611.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.99
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$854.08
|
| Rate for Payer: Healthspan PPO |
$725.17
|
| Rate for Payer: Humana Medicaid |
$332.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$611.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.64
|
| Rate for Payer: Molina Healthcare Passport |
$332.98
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$795.16
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$611.66
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
IP
|
$3,220.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
76101280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$3,091.20 |
| Rate for Payer: Aetna Commercial |
$2,479.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,511.60
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: Cigna Commercial |
$2,672.60
|
| Rate for Payer: First Health Commercial |
$3,059.00
|
| Rate for Payer: Humana Commercial |
$2,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,640.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,376.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$966.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,415.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,801.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,221.80
|
| Rate for Payer: PHCS Commercial |
$3,091.20
|
| Rate for Payer: United Healthcare All Payer |
$2,833.60
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
OP
|
$3,220.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
76101280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$3,091.20 |
| Rate for Payer: Aetna Commercial |
$2,479.40
|
| Rate for Payer: Anthem Medicaid |
$1,107.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,511.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: Cigna Commercial |
$2,672.60
|
| Rate for Payer: First Health Commercial |
$3,059.00
|
| Rate for Payer: Humana Commercial |
$2,737.00
|
| Rate for Payer: Humana KY Medicaid |
$1,107.36
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,640.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,376.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,415.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,801.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,221.80
|
| Rate for Payer: PHCS Commercial |
$3,091.20
|
| Rate for Payer: United Healthcare All Payer |
$2,833.60
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Professional
|
Both
|
$3,220.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
76101280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$1,932.00 |
| Rate for Payer: Ambetter Exchange |
$80.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.63
|
| Rate for Payer: Anthem Medicaid |
$103.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.25
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: Cash Price |
$1,610.00
|
| Rate for Payer: Cigna Commercial |
$160.18
|
| Rate for Payer: Humana Medicaid |
$103.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.00
|
| Rate for Payer: Molina Healthcare Passport |
$103.92
|
| Rate for Payer: Multiplan PHCS |
$1,932.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.27
|
| Rate for Payer: UHCCP Medicaid |
$75.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.21
|
|
|
RMVL SUBQ CAR RHYTHM MNTR(P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
761P1280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Ambetter Exchange |
$80.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.63
|
| Rate for Payer: Anthem Medicaid |
$103.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.25
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$160.18
|
| Rate for Payer: Humana Medicaid |
$103.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.00
|
| Rate for Payer: Molina Healthcare Passport |
$103.92
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.27
|
| Rate for Payer: UHCCP Medicaid |
$75.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.21
|
|
|
RMVL SUBQ CAR RHYTHM MNTR(T
|
Facility
|
IP
|
$2,930.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
761T1280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$879.00 |
| Max. Negotiated Rate |
$2,812.80 |
| Rate for Payer: Aetna Commercial |
$2,256.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,285.40
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cigna Commercial |
$2,431.90
|
| Rate for Payer: First Health Commercial |
$2,783.50
|
| Rate for Payer: Humana Commercial |
$2,490.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,402.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,162.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$879.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,578.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,197.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,549.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,021.70
|
| Rate for Payer: PHCS Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Payer |
$2,578.40
|
|
|
RMVL SUBQ CAR RHYTHM MNTR(T
|
Facility
|
OP
|
$2,930.00
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
761T1280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,812.80 |
| Rate for Payer: Aetna Commercial |
$2,256.10
|
| Rate for Payer: Anthem Medicaid |
$1,007.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,285.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cigna Commercial |
$2,431.90
|
| Rate for Payer: First Health Commercial |
$2,783.50
|
| Rate for Payer: Humana Commercial |
$2,490.50
|
| Rate for Payer: Humana KY Medicaid |
$1,007.63
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,017.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,402.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,162.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,027.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,578.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,197.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,549.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,021.70
|
| Rate for Payer: PHCS Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Payer |
$2,578.40
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
63600059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$9.51
|
| Rate for Payer: Ambetter Exchange |
$4.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.75
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Healthspan PPO |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.79
|
| Rate for Payer: Multiplan PHCS |
$70.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.23
|
| Rate for Payer: UHCCP Medicaid |
$40.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.79
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
25002355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
25002355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
636T0059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ROBAXINMETHOCARB 1000MG/10MLVL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS J2800
|
| Hospital Charge Code |
636T0059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
ROBAXIN (METHOCARBA 500MG/1TAB
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
25001337
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
ROBAXIN (METHOCARBA 500MG/1TAB
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
25001337
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
ROBAXIN (METHOCARBA 750MG/1TAB
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 70010077001
|
| Hospital Charge Code |
25001338
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
ROBAXIN (METHOCARBA 750MG/1TAB
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 70010077001
|
| Hospital Charge Code |
25001338
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
ROBINSON CUPPED PISTON 4.0 LG
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
ROBINSON CUPPED PISTON 4.0 LG
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem Medicaid |
$603.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Humana KY Medicaid |
$603.89
|
| Rate for Payer: Kentucky WC Medicaid |
$610.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
ROBINSON CUPPED PISTON 4.5 LG
|
Facility
|
OP
|
$1,763.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.08 |
| Max. Negotiated Rate |
$1,693.06 |
| Rate for Payer: Aetna Commercial |
$1,357.97
|
| Rate for Payer: Anthem Medicaid |
$606.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.61
|
| Rate for Payer: Cash Price |
$881.80
|
| Rate for Payer: Cigna Commercial |
$1,463.79
|
| Rate for Payer: First Health Commercial |
$1,675.42
|
| Rate for Payer: Humana Commercial |
$1,499.06
|
| Rate for Payer: Humana KY Medicaid |
$606.50
|
| Rate for Payer: Kentucky WC Medicaid |
$612.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,446.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.88
|
| Rate for Payer: PHCS Commercial |
$1,693.06
|
| Rate for Payer: United Healthcare All Payer |
$1,551.97
|
|
|
ROBINSON CUPPED PISTON 4.5 LG
|
Facility
|
IP
|
$1,763.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.08 |
| Max. Negotiated Rate |
$1,693.06 |
| Rate for Payer: Aetna Commercial |
$1,357.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.61
|
| Rate for Payer: Cash Price |
$881.80
|
| Rate for Payer: Cigna Commercial |
$1,463.79
|
| Rate for Payer: First Health Commercial |
$1,675.42
|
| Rate for Payer: Humana Commercial |
$1,499.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,446.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.88
|
| Rate for Payer: PHCS Commercial |
$1,693.06
|
| Rate for Payer: United Healthcare All Payer |
$1,551.97
|
|
|
ROBINUL 1 MG TABLET
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
25001339
|
|
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
|
|
|
ROBINUL 1 MG TABLET
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
25001339
|
|
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
|
|
