|
SOL SYS 8 ST SMLL STATURSZ13.5
|
Facility
|
IP
|
$75,648.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,834.29 |
| Max. Negotiated Rate |
$72,622.46 |
| Rate for Payer: Aetna Commercial |
$58,249.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,005.75
|
| Rate for Payer: Cash Price |
$37,824.20
|
| Rate for Payer: Cigna Commercial |
$62,788.17
|
| Rate for Payer: First Health Commercial |
$71,865.98
|
| Rate for Payer: Humana Commercial |
$64,301.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,031.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,828.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,694.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,570.59
|
| Rate for Payer: Ohio Health Group HMO |
$56,736.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,129.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,834.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,451.00
|
| Rate for Payer: PHCS Commercial |
$72,622.46
|
| Rate for Payer: United Healthcare All Payer |
$66,570.59
|
|
|
SOL SYS FEM STEM 12/14 TPR STR
|
Facility
|
IP
|
$75,773.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,850.53 |
| Max. Negotiated Rate |
$72,742.39 |
| Rate for Payer: Aetna Commercial |
$58,345.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,103.19
|
| Rate for Payer: Cash Price |
$37,886.66
|
| Rate for Payer: Cigna Commercial |
$62,891.86
|
| Rate for Payer: First Health Commercial |
$71,984.65
|
| Rate for Payer: Humana Commercial |
$64,407.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,134.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,920.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,732.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,680.52
|
| Rate for Payer: Ohio Health Group HMO |
$56,829.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,154.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,850.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,489.73
|
| Rate for Payer: PHCS Commercial |
$72,742.39
|
| Rate for Payer: United Healthcare All Payer |
$66,680.52
|
|
|
SOL SYS FEM STEM 12/14 TPR STR
|
Facility
|
OP
|
$75,773.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,850.53 |
| Max. Negotiated Rate |
$72,742.39 |
| Rate for Payer: Aetna Commercial |
$58,345.46
|
| Rate for Payer: Anthem Medicaid |
$26,058.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,103.19
|
| Rate for Payer: Cash Price |
$37,886.66
|
| Rate for Payer: Cigna Commercial |
$62,891.86
|
| Rate for Payer: First Health Commercial |
$71,984.65
|
| Rate for Payer: Humana Commercial |
$64,407.32
|
| Rate for Payer: Humana KY Medicaid |
$26,058.44
|
| Rate for Payer: Kentucky WC Medicaid |
$26,323.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,134.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,920.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,732.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,581.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,680.52
|
| Rate for Payer: Ohio Health Group HMO |
$56,829.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,154.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,850.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,489.73
|
| Rate for Payer: PHCS Commercial |
$72,742.39
|
| Rate for Payer: United Healthcare All Payer |
$66,680.52
|
|
|
SOLU CORTEF 100MG(500MG/4ML)
|
Facility
|
IP
|
$348.31
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25003826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.28 |
| Max. Negotiated Rate |
$334.38 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.68
|
| Rate for Payer: Cash Price |
$174.16
|
| Rate for Payer: Cigna Commercial |
$289.10
|
| Rate for Payer: First Health Commercial |
$330.89
|
| Rate for Payer: Humana Commercial |
$296.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.51
|
| Rate for Payer: Ohio Health Group HMO |
$261.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.98
|
| Rate for Payer: PHCS Commercial |
$334.38
|
| Rate for Payer: United Healthcare All Payer |
$306.51
|
|
|
SOLU CORTEF 100MG(500MG/4ML)
|
Facility
|
OP
|
$348.31
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25003826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.28 |
| Max. Negotiated Rate |
$334.38 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Anthem Medicaid |
$119.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.68
|
| Rate for Payer: Cash Price |
$174.16
|
| Rate for Payer: Cigna Commercial |
$289.10
|
| Rate for Payer: First Health Commercial |
$330.89
|
| Rate for Payer: Humana Commercial |
$296.06
|
| Rate for Payer: Humana KY Medicaid |
$119.78
|
| Rate for Payer: Kentucky WC Medicaid |
$121.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.51
|
| Rate for Payer: Ohio Health Group HMO |
$261.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.98
|
| Rate for Payer: PHCS Commercial |
$334.38
|
| Rate for Payer: United Healthcare All Payer |
$306.51
|
|
|
SOLU CORTEF(HYDROCOR 100MG/2ML
|
Facility
|
IP
|
$128.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.17
|
| Rate for Payer: Cash Price |
$64.21
|
| Rate for Payer: Cigna Commercial |
$106.59
|
| Rate for Payer: First Health Commercial |
$122.00
|
| Rate for Payer: Humana Commercial |
$109.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.01
|
| Rate for Payer: Ohio Health Group HMO |
$96.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.81
|
| Rate for Payer: PHCS Commercial |
$123.28
|
| Rate for Payer: United Healthcare All Payer |
$113.01
|
|
|
SOLU CORTEF(HYDROCOR 100MG/2ML
|
Facility
|
OP
|
$128.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Anthem Medicaid |
$44.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.17
|
| Rate for Payer: Cash Price |
$64.21
|
| Rate for Payer: Cigna Commercial |
$106.59
|
| Rate for Payer: First Health Commercial |
$122.00
|
| Rate for Payer: Humana Commercial |
$109.16
|
| Rate for Payer: Humana KY Medicaid |
$44.16
|
| Rate for Payer: Kentucky WC Medicaid |
$44.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.01
|
| Rate for Payer: Ohio Health Group HMO |
$96.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.81
|
| Rate for Payer: PHCS Commercial |
$123.28
|
| Rate for Payer: United Healthcare All Payer |
$113.01
|
|
|
SOLU CORTEF(HYDROCOR 250MG/2ML
|
Facility
|
OP
|
$195.64
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna Commercial |
$150.64
|
| Rate for Payer: Anthem Medicaid |
$67.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.60
|
| Rate for Payer: Cash Price |
$97.82
|
| Rate for Payer: Cigna Commercial |
$162.38
|
| Rate for Payer: First Health Commercial |
$185.86
|
| Rate for Payer: Humana Commercial |
$166.29
|
| Rate for Payer: Humana KY Medicaid |
$67.28
|
| Rate for Payer: Kentucky WC Medicaid |
$67.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.16
|
| Rate for Payer: Ohio Health Group HMO |
$146.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.65
|
| Rate for Payer: PHCS Commercial |
$187.81
|
| Rate for Payer: United Healthcare All Payer |
$172.16
|
|
|
SOLU CORTEF(HYDROCOR 250MG/2ML
|
Facility
|
IP
|
$195.64
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$187.81 |
| Rate for Payer: Aetna Commercial |
$150.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.60
|
| Rate for Payer: Cash Price |
$97.82
|
| Rate for Payer: Cigna Commercial |
$162.38
|
| Rate for Payer: First Health Commercial |
$185.86
|
| Rate for Payer: Humana Commercial |
$166.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.16
|
| Rate for Payer: Ohio Health Group HMO |
$146.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.65
|
| Rate for Payer: PHCS Commercial |
$187.81
|
| Rate for Payer: United Healthcare All Payer |
$172.16
|
|
|
SOLU MEDROL 125MG(500MG/4ML)
|
Facility
|
IP
|
$126.28
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
63600062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.50
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Cigna Commercial |
$104.81
|
| Rate for Payer: First Health Commercial |
$119.97
|
| Rate for Payer: Humana Commercial |
$107.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.13
|
| Rate for Payer: Ohio Health Group HMO |
$94.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.15
|
| Rate for Payer: PHCS Commercial |
$121.23
|
| Rate for Payer: United Healthcare All Payer |
$111.13
|
|
|
SOLU MEDROL 125MG(500MG/4ML)
|
Professional
|
Both
|
$126.28
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
63600062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Aetna Commercial |
$7.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Healthspan PPO |
$5.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.21
|
| Rate for Payer: Multiplan PHCS |
$75.77
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.40
|
| Rate for Payer: UHCCP Medicaid |
$44.20
|
|
|
SOLU MEDROL 125MG(500MG/4ML)
|
Facility
|
OP
|
$126.28
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
63600062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Anthem Medicaid |
$43.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.50
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Cigna Commercial |
$104.81
|
| Rate for Payer: First Health Commercial |
$119.97
|
| Rate for Payer: Humana Commercial |
$107.34
|
| Rate for Payer: Humana KY Medicaid |
$43.43
|
| Rate for Payer: Kentucky WC Medicaid |
$43.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.13
|
| Rate for Payer: Ohio Health Group HMO |
$94.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.15
|
| Rate for Payer: PHCS Commercial |
$121.23
|
| Rate for Payer: United Healthcare All Payer |
$111.13
|
|
|
SOLU MEDROL 125MG(500MG/4ML)
|
Facility
|
OP
|
$126.28
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
636T0062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Anthem Medicaid |
$43.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.50
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Cigna Commercial |
$104.81
|
| Rate for Payer: First Health Commercial |
$119.97
|
| Rate for Payer: Humana Commercial |
$107.34
|
| Rate for Payer: Humana KY Medicaid |
$43.43
|
| Rate for Payer: Kentucky WC Medicaid |
$43.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.13
|
| Rate for Payer: Ohio Health Group HMO |
$94.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.15
|
| Rate for Payer: PHCS Commercial |
$121.23
|
| Rate for Payer: United Healthcare All Payer |
$111.13
|
|
|
SOLU MEDROL 125MG(500MG/4ML)
|
Facility
|
IP
|
$126.28
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
636T0062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.50
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Cigna Commercial |
$104.81
|
| Rate for Payer: First Health Commercial |
$119.97
|
| Rate for Payer: Humana Commercial |
$107.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.13
|
| Rate for Payer: Ohio Health Group HMO |
$94.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.15
|
| Rate for Payer: PHCS Commercial |
$121.23
|
| Rate for Payer: United Healthcare All Payer |
$111.13
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
IP
|
$116.74
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.19
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
OP
|
$116.74
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Humana KY Medicaid |
$40.15
|
| Rate for Payer: Kentucky WC Medicaid |
$40.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.19
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
SOLU-MEDROL 5MG (2GM SDV)
|
Facility
|
IP
|
$536.86
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$515.39 |
| Rate for Payer: Aetna Commercial |
$413.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.75
|
| Rate for Payer: Cash Price |
$268.43
|
| Rate for Payer: Cigna Commercial |
$445.59
|
| Rate for Payer: First Health Commercial |
$510.02
|
| Rate for Payer: Humana Commercial |
$456.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.44
|
| Rate for Payer: Ohio Health Group HMO |
$402.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.43
|
| Rate for Payer: PHCS Commercial |
$515.39
|
| Rate for Payer: United Healthcare All Payer |
$472.44
|
|
|
SOLU-MEDROL 5MG (2GM SDV)
|
Facility
|
OP
|
$536.86
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$515.39 |
| Rate for Payer: Aetna Commercial |
$413.38
|
| Rate for Payer: Anthem Medicaid |
$184.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.75
|
| Rate for Payer: Cash Price |
$268.43
|
| Rate for Payer: Cigna Commercial |
$445.59
|
| Rate for Payer: First Health Commercial |
$510.02
|
| Rate for Payer: Humana Commercial |
$456.33
|
| Rate for Payer: Humana KY Medicaid |
$184.63
|
| Rate for Payer: Kentucky WC Medicaid |
$186.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.44
|
| Rate for Payer: Ohio Health Group HMO |
$402.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.43
|
| Rate for Payer: PHCS Commercial |
$515.39
|
| Rate for Payer: United Healthcare All Payer |
$472.44
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
OP
|
$113.05
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$108.53 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Anthem Medicaid |
$38.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.18
|
| Rate for Payer: Cash Price |
$56.52
|
| Rate for Payer: Cigna Commercial |
$93.83
|
| Rate for Payer: First Health Commercial |
$107.40
|
| Rate for Payer: Humana Commercial |
$96.09
|
| Rate for Payer: Humana KY Medicaid |
$38.88
|
| Rate for Payer: Kentucky WC Medicaid |
$39.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.48
|
| Rate for Payer: Ohio Health Group HMO |
$84.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.05
|
| Rate for Payer: PHCS Commercial |
$108.53
|
| Rate for Payer: United Healthcare All Payer |
$99.48
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
IP
|
$113.05
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$108.53 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.18
|
| Rate for Payer: Cash Price |
$56.52
|
| Rate for Payer: Cigna Commercial |
$93.83
|
| Rate for Payer: First Health Commercial |
$107.40
|
| Rate for Payer: Humana Commercial |
$96.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.48
|
| Rate for Payer: Ohio Health Group HMO |
$84.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.05
|
| Rate for Payer: PHCS Commercial |
$108.53
|
| Rate for Payer: United Healthcare All Payer |
$99.48
|
|
|
SOLU MEDROL 5MG(500MG/4ML)
|
Facility
|
OP
|
$131.28
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Anthem Medicaid |
$45.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.40
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cigna Commercial |
$108.96
|
| Rate for Payer: First Health Commercial |
$124.72
|
| Rate for Payer: Humana Commercial |
$111.59
|
| Rate for Payer: Humana KY Medicaid |
$45.15
|
| Rate for Payer: Kentucky WC Medicaid |
$45.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.53
|
| Rate for Payer: Ohio Health Group HMO |
$98.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.70
|
| Rate for Payer: PHCS Commercial |
$126.03
|
| Rate for Payer: United Healthcare All Payer |
$115.53
|
|
|
SOLU MEDROL 5MG(500MG/4ML)
|
Facility
|
IP
|
$131.28
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.40
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cigna Commercial |
$108.96
|
| Rate for Payer: First Health Commercial |
$124.72
|
| Rate for Payer: Humana Commercial |
$111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.53
|
| Rate for Payer: Ohio Health Group HMO |
$98.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.70
|
| Rate for Payer: PHCS Commercial |
$126.03
|
| Rate for Payer: United Healthcare All Payer |
$115.53
|
|
|
SOLU-MEDROL 5MG (500mg SDV)
|
Facility
|
OP
|
$203.38
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25003760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$195.24 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Anthem Medicaid |
$69.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.64
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cigna Commercial |
$168.81
|
| Rate for Payer: First Health Commercial |
$193.21
|
| Rate for Payer: Humana Commercial |
$172.87
|
| Rate for Payer: Humana KY Medicaid |
$69.94
|
| Rate for Payer: Kentucky WC Medicaid |
$70.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.97
|
| Rate for Payer: Ohio Health Group HMO |
$152.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.05
|
| Rate for Payer: PHCS Commercial |
$195.24
|
| Rate for Payer: United Healthcare All Payer |
$178.97
|
|
|
SOLU-MEDROL 5MG (500mg SDV)
|
Facility
|
IP
|
$203.38
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25003760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$195.24 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.64
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cigna Commercial |
$168.81
|
| Rate for Payer: First Health Commercial |
$193.21
|
| Rate for Payer: Humana Commercial |
$172.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.97
|
| Rate for Payer: Ohio Health Group HMO |
$152.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.05
|
| Rate for Payer: PHCS Commercial |
$195.24
|
| Rate for Payer: United Healthcare All Payer |
$178.97
|
|
|
SOLU MEDROL (METHYLP 125MG/2ML
|
Professional
|
Both
|
$111.74
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
63600061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$7.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.74
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Healthspan PPO |
$5.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.21
|
| Rate for Payer: Multiplan PHCS |
$67.04
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.22
|
| Rate for Payer: UHCCP Medicaid |
$39.11
|
|
