|
ROTALINK BURR 1.75MM
|
Facility
|
OP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem Medicaid |
$3,448.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Humana KY Medicaid |
$3,448.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ROTALINK PLUS 1.25MM
|
Facility
|
IP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ROTALINK PLUS 1.25MM
|
Facility
|
OP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem Medicaid |
$3,448.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Humana KY Medicaid |
$3,448.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ROTALINK PLUS 1.50MM
|
Facility
|
IP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ROTALINK PLUS 1.50MM
|
Facility
|
OP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem Medicaid |
$3,448.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Humana KY Medicaid |
$3,448.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ROTAREX SET 6F 135CM
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
ROTAREX SET 6F 135CM
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
ROTAREX SET 8F 110CM
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
ROTAREX SET 8F 110CM
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
ROTAVIRUS DETECTION
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
30001358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
ROTAVIRUS DETECTION
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
30001358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
ROTAWIRE FLOPPY
|
Facility
|
IP
|
$1,895.84
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$1,820.01 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.76
|
| Rate for Payer: Cash Price |
$947.92
|
| Rate for Payer: Cigna Commercial |
$1,573.55
|
| Rate for Payer: First Health Commercial |
$1,801.05
|
| Rate for Payer: Humana Commercial |
$1,611.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,516.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.13
|
| Rate for Payer: PHCS Commercial |
$1,820.01
|
| Rate for Payer: United Healthcare All Payer |
$1,668.34
|
|
|
ROTAWIRE FLOPPY
|
Facility
|
OP
|
$1,895.84
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$1,820.01 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Anthem Medicaid |
$651.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.76
|
| Rate for Payer: Cash Price |
$947.92
|
| Rate for Payer: Cigna Commercial |
$1,573.55
|
| Rate for Payer: First Health Commercial |
$1,801.05
|
| Rate for Payer: Humana Commercial |
$1,611.46
|
| Rate for Payer: Humana KY Medicaid |
$651.98
|
| Rate for Payer: Kentucky WC Medicaid |
$658.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,516.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.13
|
| Rate for Payer: PHCS Commercial |
$1,820.01
|
| Rate for Payer: United Healthcare All Payer |
$1,668.34
|
|
|
ROTAWIRE X-SUPPORT
|
Facility
|
OP
|
$1,895.84
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$1,820.01 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Anthem Medicaid |
$651.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.76
|
| Rate for Payer: Cash Price |
$947.92
|
| Rate for Payer: Cigna Commercial |
$1,573.55
|
| Rate for Payer: First Health Commercial |
$1,801.05
|
| Rate for Payer: Humana Commercial |
$1,611.46
|
| Rate for Payer: Humana KY Medicaid |
$651.98
|
| Rate for Payer: Kentucky WC Medicaid |
$658.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,516.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.13
|
| Rate for Payer: PHCS Commercial |
$1,820.01
|
| Rate for Payer: United Healthcare All Payer |
$1,668.34
|
|
|
ROTAWIRE X-SUPPORT
|
Facility
|
IP
|
$1,895.84
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$1,820.01 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.76
|
| Rate for Payer: Cash Price |
$947.92
|
| Rate for Payer: Cigna Commercial |
$1,573.55
|
| Rate for Payer: First Health Commercial |
$1,801.05
|
| Rate for Payer: Humana Commercial |
$1,611.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,516.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.13
|
| Rate for Payer: PHCS Commercial |
$1,820.01
|
| Rate for Payer: United Healthcare All Payer |
$1,668.34
|
|
|
ROUGH PIGWEED IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ROUGH PIGWEED IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ROWASA (MESALAMINE) ENEMA 60ML
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
NDC 62559042011
|
| Hospital Charge Code |
25001347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.69
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna Commercial |
$25.21
|
| Rate for Payer: First Health Commercial |
$28.85
|
| Rate for Payer: Humana Commercial |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.73
|
| Rate for Payer: Ohio Health Group HMO |
$22.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.96
|
| Rate for Payer: PHCS Commercial |
$29.16
|
| Rate for Payer: United Healthcare All Payer |
$26.73
|
|
|
ROWASA (MESALAMINE) ENEMA 60ML
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
NDC 62559042011
|
| Hospital Charge Code |
25001347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Anthem Medicaid |
$10.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.69
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna Commercial |
$25.21
|
| Rate for Payer: First Health Commercial |
$28.85
|
| Rate for Payer: Humana Commercial |
$25.81
|
| Rate for Payer: Humana KY Medicaid |
$10.44
|
| Rate for Payer: Kentucky WC Medicaid |
$10.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.73
|
| Rate for Payer: Ohio Health Group HMO |
$22.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.96
|
| Rate for Payer: PHCS Commercial |
$29.16
|
| Rate for Payer: United Healthcare All Payer |
$26.73
|
|
|
ROXANOL 10MG/.5ML EQORSOL .5ML
|
Facility
|
OP
|
$60.28
|
|
|
Service Code
|
NDC 406800330
|
| Hospital Charge Code |
25001349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$57.87 |
| Rate for Payer: Aetna Commercial |
$46.42
|
| Rate for Payer: Anthem Medicaid |
$20.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.02
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cigna Commercial |
$50.03
|
| Rate for Payer: First Health Commercial |
$57.27
|
| Rate for Payer: Humana Commercial |
$51.24
|
| Rate for Payer: Humana KY Medicaid |
$20.73
|
| Rate for Payer: Kentucky WC Medicaid |
$20.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.05
|
| Rate for Payer: Ohio Health Group HMO |
$45.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.59
|
| Rate for Payer: PHCS Commercial |
$57.87
|
| Rate for Payer: United Healthcare All Payer |
$53.05
|
|
|
ROXANOL 10MG/.5ML EQORSOL .5ML
|
Facility
|
IP
|
$60.28
|
|
|
Service Code
|
NDC 406800330
|
| Hospital Charge Code |
25001349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$57.87 |
| Rate for Payer: Aetna Commercial |
$46.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.02
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cigna Commercial |
$50.03
|
| Rate for Payer: First Health Commercial |
$57.27
|
| Rate for Payer: Humana Commercial |
$51.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.05
|
| Rate for Payer: Ohio Health Group HMO |
$45.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.59
|
| Rate for Payer: PHCS Commercial |
$57.87
|
| Rate for Payer: United Healthcare All Payer |
$53.05
|
|
|
ROZATROL 50 ML GBL
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
22200149
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem Medicaid |
$30.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.64
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Humana KY Medicaid |
$30.26
|
| Rate for Payer: Kentucky WC Medicaid |
$30.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.72
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
ROZATROL 50 ML GBL
|
Professional
|
Both
|
$88.00
|
|
| Hospital Charge Code |
22200149
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$61.60 |
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Multiplan PHCS |
$52.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.60
|
| Rate for Payer: UHCCP Medicaid |
$30.80
|
|
|
ROZATROL 50 ML GBL
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
22200149
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.64
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.72
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
RP LOCLZJ TUM SPECT 2 AREAS
|
Facility
|
OP
|
$2,294.00
|
|
|
Service Code
|
HCPCS 78831
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$788.91 |
| Max. Negotiated Rate |
$2,202.24 |
| Rate for Payer: Aetna Commercial |
$1,766.38
|
| Rate for Payer: Anthem Medicaid |
$788.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,789.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cigna Commercial |
$1,904.02
|
| Rate for Payer: First Health Commercial |
$2,179.30
|
| Rate for Payer: Humana Commercial |
$1,949.90
|
| Rate for Payer: Humana KY Medicaid |
$788.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$796.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,881.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,692.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$804.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,018.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,720.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,835.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,995.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,582.86
|
| Rate for Payer: PHCS Commercial |
$2,202.24
|
| Rate for Payer: United Healthcare All Payer |
$2,018.72
|
|
