|
SOLU MEDROL (METHYLP 125MG/2ML
|
Facility
|
OP
|
$111.74
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
636T0061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem Medicaid |
$38.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Humana KY Medicaid |
$38.43
|
| Rate for Payer: Kentucky WC Medicaid |
$38.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SOLU MEDROL (METHYLP 125MG/2ML
|
Facility
|
IP
|
$111.74
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
636T0061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SOLU MEDROL (METHYLP 125MG/2ML
|
Facility
|
IP
|
$111.74
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
63600061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SOLU MEDROL (METHYLP 125MG/2ML
|
Facility
|
OP
|
$111.74
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
63600061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem Medicaid |
$38.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Humana KY Medicaid |
$38.43
|
| Rate for Payer: Kentucky WC Medicaid |
$38.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SOLU MEDROL(METHYLPRE 40MG/1ML
|
Facility
|
IP
|
$108.05
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
636T0060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$83.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.28
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.68
|
| Rate for Payer: First Health Commercial |
$102.65
|
| Rate for Payer: Humana Commercial |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.08
|
| Rate for Payer: Ohio Health Group HMO |
$81.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.73
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
SOLU MEDROL(METHYLPRE 40MG/1ML
|
Professional
|
Both
|
$108.05
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
63600060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.05
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.07
|
| Rate for Payer: Multiplan PHCS |
$64.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.64
|
| Rate for Payer: UHCCP Medicaid |
$37.82
|
|
|
SOLU MEDROL(METHYLPRE 40MG/1ML
|
Facility
|
OP
|
$108.05
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
63600060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$83.20
|
| Rate for Payer: Anthem Medicaid |
$37.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.28
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.68
|
| Rate for Payer: First Health Commercial |
$102.65
|
| Rate for Payer: Humana Commercial |
$91.84
|
| Rate for Payer: Humana KY Medicaid |
$37.16
|
| Rate for Payer: Kentucky WC Medicaid |
$37.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.08
|
| Rate for Payer: Ohio Health Group HMO |
$81.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.73
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
SOLU MEDROL(METHYLPRE 40MG/1ML
|
Professional
|
Both
|
$108.05
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
25002362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.05
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.07
|
| Rate for Payer: Multiplan PHCS |
$64.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.64
|
| Rate for Payer: UHCCP Medicaid |
$37.82
|
|
|
SOLU MEDROL(METHYLPRE 40MG/1ML
|
Facility
|
IP
|
$108.05
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
63600060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$83.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.28
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.68
|
| Rate for Payer: First Health Commercial |
$102.65
|
| Rate for Payer: Humana Commercial |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.08
|
| Rate for Payer: Ohio Health Group HMO |
$81.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.73
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
SOLU MEDROL(METHYLPRE 40MG/1ML
|
Facility
|
OP
|
$108.05
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
636T0060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$83.20
|
| Rate for Payer: Anthem Medicaid |
$37.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.28
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.68
|
| Rate for Payer: First Health Commercial |
$102.65
|
| Rate for Payer: Humana Commercial |
$91.84
|
| Rate for Payer: Humana KY Medicaid |
$37.16
|
| Rate for Payer: Kentucky WC Medicaid |
$37.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.08
|
| Rate for Payer: Ohio Health Group HMO |
$81.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.73
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
SOLYX BLUE
|
Facility
|
IP
|
$8,209.12
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.19 |
| Max. Negotiated Rate |
$7,880.76 |
| Rate for Payer: Aetna Commercial |
$6,321.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,403.11
|
| Rate for Payer: Cash Price |
$4,104.56
|
| Rate for Payer: Cigna Commercial |
$6,813.57
|
| Rate for Payer: First Health Commercial |
$7,798.66
|
| Rate for Payer: Humana Commercial |
$6,977.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,731.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,058.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,462.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,224.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,156.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,067.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.83
|
| Rate for Payer: PHCS Commercial |
$7,880.76
|
| Rate for Payer: United Healthcare All Payer |
$7,224.03
|
|
|
SOLYX BLUE
|
Facility
|
OP
|
$8,209.12
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.19 |
| Max. Negotiated Rate |
$7,880.76 |
| Rate for Payer: Aetna Commercial |
$6,321.02
|
| Rate for Payer: Anthem Medicaid |
$2,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,403.11
|
| Rate for Payer: Cash Price |
$4,104.56
|
| Rate for Payer: Cigna Commercial |
$6,813.57
|
| Rate for Payer: First Health Commercial |
$7,798.66
|
| Rate for Payer: Humana Commercial |
$6,977.75
|
| Rate for Payer: Humana KY Medicaid |
$2,823.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,851.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,731.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,058.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,462.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,879.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,224.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,156.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,067.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.83
|
| Rate for Payer: PHCS Commercial |
$7,880.76
|
| Rate for Payer: United Healthcare All Payer |
$7,224.03
|
|
|
SOMA 250MG TABLET
|
Facility
|
IP
|
$62.64
|
|
|
Service Code
|
NDC 51525590101
|
| Hospital Charge Code |
25001419
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Aetna Commercial |
$48.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.86
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cigna Commercial |
$51.99
|
| Rate for Payer: First Health Commercial |
$59.51
|
| Rate for Payer: Humana Commercial |
$53.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.12
|
| Rate for Payer: Ohio Health Group HMO |
$46.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.42
|
| Rate for Payer: PHCS Commercial |
$60.13
|
| Rate for Payer: United Healthcare All Payer |
$55.12
|
|
|
SOMA 250MG TABLET
|
Facility
|
OP
|
$62.64
|
|
|
Service Code
|
NDC 51525590101
|
| Hospital Charge Code |
25001419
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Aetna Commercial |
$48.23
|
| Rate for Payer: Anthem Medicaid |
$21.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.86
|
| Rate for Payer: Cash Price |
$31.32
|
| Rate for Payer: Cigna Commercial |
$51.99
|
| Rate for Payer: First Health Commercial |
$59.51
|
| Rate for Payer: Humana Commercial |
$53.24
|
| Rate for Payer: Humana KY Medicaid |
$21.54
|
| Rate for Payer: Kentucky WC Medicaid |
$21.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.12
|
| Rate for Payer: Ohio Health Group HMO |
$46.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.42
|
| Rate for Payer: PHCS Commercial |
$60.13
|
| Rate for Payer: United Healthcare All Payer |
$55.12
|
|
|
SOMA (CARISOPRODOL) 350MG/1TAB
|
Facility
|
OP
|
$60.07
|
|
|
Service Code
|
NDC 69584011110
|
| Hospital Charge Code |
25001418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.67 |
| Rate for Payer: Aetna Commercial |
$46.25
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.85
|
| Rate for Payer: Cash Price |
$30.04
|
| Rate for Payer: Cigna Commercial |
$49.86
|
| Rate for Payer: First Health Commercial |
$57.07
|
| Rate for Payer: Humana Commercial |
$51.06
|
| Rate for Payer: Humana KY Medicaid |
$20.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.86
|
| Rate for Payer: Ohio Health Group HMO |
$45.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.62
|
| Rate for Payer: PHCS Commercial |
$57.67
|
| Rate for Payer: United Healthcare All Payer |
$52.86
|
|
|
SOMA (CARISOPRODOL) 350MG/1TAB
|
Facility
|
IP
|
$60.07
|
|
|
Service Code
|
NDC 69584011110
|
| Hospital Charge Code |
25001418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.67 |
| Rate for Payer: Aetna Commercial |
$46.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.85
|
| Rate for Payer: Cash Price |
$30.04
|
| Rate for Payer: Cigna Commercial |
$49.86
|
| Rate for Payer: First Health Commercial |
$57.07
|
| Rate for Payer: Humana Commercial |
$51.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.86
|
| Rate for Payer: Ohio Health Group HMO |
$45.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.62
|
| Rate for Payer: PHCS Commercial |
$57.67
|
| Rate for Payer: United Healthcare All Payer |
$52.86
|
|
|
SOMAGEN MESHED THIN 6*8
|
Facility
|
OP
|
$14,009.54
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.24 |
| Max. Negotiated Rate |
$13,449.16 |
| Rate for Payer: Aetna Commercial |
$10,787.35
|
| Rate for Payer: Anthem Medicaid |
$4,817.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,927.44
|
| Rate for Payer: Cash Price |
$7,004.77
|
| Rate for Payer: Cigna Commercial |
$11,627.92
|
| Rate for Payer: First Health Commercial |
$13,309.06
|
| Rate for Payer: Humana Commercial |
$11,908.11
|
| Rate for Payer: Humana KY Medicaid |
$4,817.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,866.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,487.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,339.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,202.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,914.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,328.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,507.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,801.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,342.96
|
| Rate for Payer: PHCS Commercial |
$13,449.16
|
| Rate for Payer: United Healthcare All Payer |
$12,328.40
|
|
|
SOMAGEN MESHED THIN 6*8
|
Facility
|
IP
|
$14,009.54
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.24 |
| Max. Negotiated Rate |
$13,449.16 |
| Rate for Payer: Aetna Commercial |
$10,787.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,927.44
|
| Rate for Payer: Cash Price |
$7,004.77
|
| Rate for Payer: Cigna Commercial |
$11,627.92
|
| Rate for Payer: First Health Commercial |
$13,309.06
|
| Rate for Payer: Humana Commercial |
$11,908.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,487.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,339.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,202.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,328.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,507.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,801.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,342.96
|
| Rate for Payer: PHCS Commercial |
$13,449.16
|
| Rate for Payer: United Healthcare All Payer |
$12,328.40
|
|
|
SOMAGEN MESHED THIN 8*12
|
Facility
|
IP
|
$24,899.16
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,236.89 |
| Max. Negotiated Rate |
$23,903.19 |
| Rate for Payer: Aetna Commercial |
$19,172.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,421.34
|
| Rate for Payer: Cash Price |
$12,449.58
|
| Rate for Payer: Cigna Commercial |
$20,666.30
|
| Rate for Payer: First Health Commercial |
$23,654.20
|
| Rate for Payer: Humana Commercial |
$21,164.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,417.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,375.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,469.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,911.26
|
| Rate for Payer: Ohio Health Group HMO |
$18,674.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,979.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,236.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,718.74
|
| Rate for Payer: PHCS Commercial |
$23,903.19
|
| Rate for Payer: United Healthcare All Payer |
$21,911.26
|
|
|
SOMAGEN MESHED THIN 8*12
|
Facility
|
OP
|
$24,899.16
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,236.89 |
| Max. Negotiated Rate |
$23,903.19 |
| Rate for Payer: Aetna Commercial |
$19,172.35
|
| Rate for Payer: Anthem Medicaid |
$8,562.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,421.34
|
| Rate for Payer: Cash Price |
$12,449.58
|
| Rate for Payer: Cigna Commercial |
$20,666.30
|
| Rate for Payer: First Health Commercial |
$23,654.20
|
| Rate for Payer: Humana Commercial |
$21,164.29
|
| Rate for Payer: Humana KY Medicaid |
$8,562.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,649.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,417.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,375.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,469.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,734.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,911.26
|
| Rate for Payer: Ohio Health Group HMO |
$18,674.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,979.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,236.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,718.74
|
| Rate for Payer: PHCS Commercial |
$23,903.19
|
| Rate for Payer: United Healthcare All Payer |
$21,911.26
|
|
|
SOMATOSENSORY TESTING
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 95925
|
| Hospital Charge Code |
51000039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Aetna Commercial |
$176.38
|
| Rate for Payer: Anthem Medicaid |
$59.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,335.00
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$127.74
|
| Rate for Payer: Healthspan PPO |
$155.35
|
| Rate for Payer: Humana Medicaid |
$59.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.45
|
| Rate for Payer: Molina Healthcare Passport |
$59.26
|
| Rate for Payer: Multiplan PHCS |
$801.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.50
|
| Rate for Payer: UHCCP Medicaid |
$467.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.85
|
|
|
SOMATOSENSORY TESTING
|
Facility
|
IP
|
$1,335.00
|
|
|
Service Code
|
HCPCS 95925
|
| Hospital Charge Code |
51000039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$1,281.60 |
| Rate for Payer: Aetna Commercial |
$1,027.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,041.30
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$1,108.05
|
| Rate for Payer: First Health Commercial |
$1,268.25
|
| Rate for Payer: Humana Commercial |
$1,134.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,094.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$985.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$400.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,174.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,001.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.85
|
| Rate for Payer: PHCS Commercial |
$1,281.60
|
| Rate for Payer: United Healthcare All Payer |
$1,174.80
|
|
|
SOMATOSENSORY TESTING
|
Facility
|
OP
|
$1,335.00
|
|
|
Service Code
|
HCPCS 95925
|
| Hospital Charge Code |
51000039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.55 |
| Max. Negotiated Rate |
$1,281.60 |
| Rate for Payer: Aetna Commercial |
$1,027.95
|
| Rate for Payer: Anthem Medicaid |
$459.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,041.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$1,108.05
|
| Rate for Payer: First Health Commercial |
$1,268.25
|
| Rate for Payer: Humana Commercial |
$1,134.75
|
| Rate for Payer: Humana KY Medicaid |
$459.11
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$463.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,094.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$985.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$468.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,174.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,001.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.85
|
| Rate for Payer: PHCS Commercial |
$1,281.60
|
| Rate for Payer: United Healthcare All Payer |
$1,174.80
|
|
|
SOMATOSENSORY TESTING(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 95925
|
| Hospital Charge Code |
510P0039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$176.38
|
| Rate for Payer: Anthem Medicaid |
$59.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$127.74
|
| Rate for Payer: Healthspan PPO |
$155.35
|
| Rate for Payer: Humana Medicaid |
$59.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.45
|
| Rate for Payer: Molina Healthcare Passport |
$59.26
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.85
|
|
|
SOMATOSENSORY TESTING(T
|
Facility
|
IP
|
$1,010.00
|
|
|
Service Code
|
HCPCS 95925
|
| Hospital Charge Code |
510T0039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$969.60 |
| Rate for Payer: Aetna Commercial |
$777.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$787.80
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$838.30
|
| Rate for Payer: First Health Commercial |
$959.50
|
| Rate for Payer: Humana Commercial |
$858.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$828.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$745.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$888.80
|
| Rate for Payer: Ohio Health Group HMO |
$757.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$202.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.10
|
| Rate for Payer: PHCS Commercial |
$969.60
|
| Rate for Payer: United Healthcare All Payer |
$888.80
|
|
