|
ROBINUL(GLYCOPYRROLAT .4MG/2ML
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
NDC 71288041493
|
| Hospital Charge Code |
25003421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$107.71 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Anthem Medicaid |
$38.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.52
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$93.13
|
| Rate for Payer: First Health Commercial |
$106.59
|
| Rate for Payer: Humana Commercial |
$95.37
|
| Rate for Payer: Humana KY Medicaid |
$38.59
|
| Rate for Payer: Kentucky WC Medicaid |
$38.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.74
|
| Rate for Payer: Ohio Health Group HMO |
$84.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.42
|
| Rate for Payer: PHCS Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Payer |
$98.74
|
|
|
ROBINUL(GLYCOPYRROLAT .4MG/2ML
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
NDC 71288041493
|
| Hospital Charge Code |
25003421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$107.71 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.52
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$93.13
|
| Rate for Payer: First Health Commercial |
$106.59
|
| Rate for Payer: Humana Commercial |
$95.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.74
|
| Rate for Payer: Ohio Health Group HMO |
$84.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.42
|
| Rate for Payer: PHCS Commercial |
$107.71
|
| Rate for Payer: United Healthcare All Payer |
$98.74
|
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 904653720
|
| Hospital Charge Code |
25001340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 904653720
|
| Hospital Charge Code |
25001340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 24385090434
|
| Hospital Charge Code |
25001340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ROBITUSSIN CF 10ML GUAIFENESIN
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 24385090434
|
| Hospital Charge Code |
25001340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ROBITUSSIN DM(GUAIFEN/DM) 10ML
|
Facility
|
OP
|
$10.31
|
|
|
Service Code
|
NDC 121127600
|
| Hospital Charge Code |
25001341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$7.94
|
| Rate for Payer: Anthem Medicaid |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cigna Commercial |
$8.56
|
| Rate for Payer: First Health Commercial |
$9.79
|
| Rate for Payer: Humana Commercial |
$8.76
|
| Rate for Payer: Humana KY Medicaid |
$3.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.07
|
| Rate for Payer: Ohio Health Group HMO |
$7.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.11
|
| Rate for Payer: PHCS Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Payer |
$9.07
|
|
|
ROBITUSSIN DM(GUAIFEN/DM) 10ML
|
Facility
|
IP
|
$10.31
|
|
|
Service Code
|
NDC 121127600
|
| Hospital Charge Code |
25001341
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$7.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cigna Commercial |
$8.56
|
| Rate for Payer: First Health Commercial |
$9.79
|
| Rate for Payer: Humana Commercial |
$8.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.07
|
| Rate for Payer: Ohio Health Group HMO |
$7.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.11
|
| Rate for Payer: PHCS Commercial |
$9.90
|
| Rate for Payer: United Healthcare All Payer |
$9.07
|
|
|
ROBITUSSIN(GUAIFENE 200MG/10ML
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 121148800
|
| Hospital Charge Code |
25001343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Anthem Medicaid |
$0.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.32
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna Commercial |
$1.40
|
| Rate for Payer: First Health Commercial |
$1.61
|
| Rate for Payer: Humana Commercial |
$1.44
|
| Rate for Payer: Humana KY Medicaid |
$0.58
|
| Rate for Payer: Kentucky WC Medicaid |
$0.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.49
|
| Rate for Payer: Ohio Health Group HMO |
$1.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.17
|
| Rate for Payer: PHCS Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Payer |
$1.49
|
|
|
ROBITUSSIN(GUAIFENE 200MG/10ML
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 121148800
|
| Hospital Charge Code |
25001343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna Commercial |
$1.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.32
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna Commercial |
$1.40
|
| Rate for Payer: First Health Commercial |
$1.61
|
| Rate for Payer: Humana Commercial |
$1.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.49
|
| Rate for Payer: Ohio Health Group HMO |
$1.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.17
|
| Rate for Payer: PHCS Commercial |
$1.62
|
| Rate for Payer: United Healthcare All Payer |
$1.49
|
|
|
ROCALTROL(CALCITRI .25MCG/1CAP
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
25001344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.85
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna Commercial |
$4.10
|
| Rate for Payer: First Health Commercial |
$4.69
|
| Rate for Payer: Humana Commercial |
$4.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.35
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.41
|
| Rate for Payer: PHCS Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Payer |
$4.35
|
|
|
ROCALTROL(CALCITRI .25MCG/1CAP
|
Facility
|
OP
|
$4.94
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
25001344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.85
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cigna Commercial |
$4.10
|
| Rate for Payer: First Health Commercial |
$4.69
|
| Rate for Payer: Humana Commercial |
$4.20
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.35
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.41
|
| Rate for Payer: PHCS Commercial |
$4.74
|
| Rate for Payer: United Healthcare All Payer |
$4.35
|
|
|
ROCEPHIN 250 MG(1GM/10ML)
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.49
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250 MG(1GM/10ML)
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Humana KY Medicaid |
$26.66
|
| Rate for Payer: Kentucky WC Medicaid |
$26.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.49
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250 MG[2GM] EQUIV VIA
|
Facility
|
IP
|
$78.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.53
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$65.48
|
| Rate for Payer: First Health Commercial |
$74.95
|
| Rate for Payer: Humana Commercial |
$67.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.42
|
| Rate for Payer: Ohio Health Group HMO |
$59.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.43
|
| Rate for Payer: PHCS Commercial |
$75.73
|
| Rate for Payer: United Healthcare All Payer |
$69.42
|
|
|
ROCEPHIN 250 MG[2GM] EQUIV VIA
|
Facility
|
OP
|
$78.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Anthem Medicaid |
$27.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.53
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$65.48
|
| Rate for Payer: First Health Commercial |
$74.95
|
| Rate for Payer: Humana Commercial |
$67.06
|
| Rate for Payer: Humana KY Medicaid |
$27.13
|
| Rate for Payer: Kentucky WC Medicaid |
$27.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.42
|
| Rate for Payer: Ohio Health Group HMO |
$59.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.43
|
| Rate for Payer: PHCS Commercial |
$75.73
|
| Rate for Payer: United Healthcare All Payer |
$69.42
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Professional
|
Both
|
$31.99
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Ambetter Exchange |
$0.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Healthspan PPO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Multiplan PHCS |
$19.19
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.62
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.48
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
OP
|
$63.97
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$61.41 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Anthem Medicaid |
$22.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.90
|
| Rate for Payer: Cash Price |
$31.98
|
| Rate for Payer: Cigna Commercial |
$53.10
|
| Rate for Payer: First Health Commercial |
$60.77
|
| Rate for Payer: Humana Commercial |
$54.37
|
| Rate for Payer: Humana KY Medicaid |
$22.00
|
| Rate for Payer: Kentucky WC Medicaid |
$22.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.29
|
| Rate for Payer: Ohio Health Group HMO |
$47.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.14
|
| Rate for Payer: PHCS Commercial |
$61.41
|
| Rate for Payer: United Healthcare All Payer |
$56.29
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
OP
|
$31.99
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Anthem Medicaid |
$11.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.95
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cigna Commercial |
$26.55
|
| Rate for Payer: First Health Commercial |
$30.39
|
| Rate for Payer: Humana Commercial |
$27.19
|
| Rate for Payer: Humana KY Medicaid |
$11.00
|
| Rate for Payer: Kentucky WC Medicaid |
$11.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.15
|
| Rate for Payer: Ohio Health Group HMO |
$23.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.07
|
| Rate for Payer: PHCS Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Payer |
$28.15
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
OP
|
$31.99
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Anthem Medicaid |
$11.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.95
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cigna Commercial |
$26.55
|
| Rate for Payer: First Health Commercial |
$30.39
|
| Rate for Payer: Humana Commercial |
$27.19
|
| Rate for Payer: Humana KY Medicaid |
$11.00
|
| Rate for Payer: Kentucky WC Medicaid |
$11.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.15
|
| Rate for Payer: Ohio Health Group HMO |
$23.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.07
|
| Rate for Payer: PHCS Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Payer |
$28.15
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
IP
|
$31.99
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.95
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cigna Commercial |
$26.55
|
| Rate for Payer: First Health Commercial |
$30.39
|
| Rate for Payer: Humana Commercial |
$27.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.15
|
| Rate for Payer: Ohio Health Group HMO |
$23.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.07
|
| Rate for Payer: PHCS Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Payer |
$28.15
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
IP
|
$31.99
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.95
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cigna Commercial |
$26.55
|
| Rate for Payer: First Health Commercial |
$30.39
|
| Rate for Payer: Humana Commercial |
$27.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.15
|
| Rate for Payer: Ohio Health Group HMO |
$23.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.07
|
| Rate for Payer: PHCS Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Payer |
$28.15
|
|
|
ROCEPHIN 250MG (500MG VIAL)
|
Facility
|
IP
|
$63.97
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$61.41 |
| Rate for Payer: Aetna Commercial |
$49.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.90
|
| Rate for Payer: Cash Price |
$31.98
|
| Rate for Payer: Cigna Commercial |
$53.10
|
| Rate for Payer: First Health Commercial |
$60.77
|
| Rate for Payer: Humana Commercial |
$54.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.29
|
| Rate for Payer: Ohio Health Group HMO |
$47.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.14
|
| Rate for Payer: PHCS Commercial |
$61.41
|
| Rate for Payer: United Healthcare All Payer |
$56.29
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
IP
|
$19.38
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.12
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cigna Commercial |
$16.09
|
| Rate for Payer: First Health Commercial |
$18.41
|
| Rate for Payer: Humana Commercial |
$16.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.05
|
| Rate for Payer: Ohio Health Group HMO |
$14.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.37
|
| Rate for Payer: PHCS Commercial |
$18.60
|
| Rate for Payer: United Healthcare All Payer |
$17.05
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
OP
|
$19.38
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Anthem Medicaid |
$6.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.12
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cigna Commercial |
$16.09
|
| Rate for Payer: First Health Commercial |
$18.41
|
| Rate for Payer: Humana Commercial |
$16.47
|
| Rate for Payer: Humana KY Medicaid |
$6.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.05
|
| Rate for Payer: Ohio Health Group HMO |
$14.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.37
|
| Rate for Payer: PHCS Commercial |
$18.60
|
| Rate for Payer: United Healthcare All Payer |
$17.05
|
|
