|
SOL SYS 8 ST SMLL STATURSZ13.5
|
Facility
|
OP
|
$78,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,463.66 |
| Max. Negotiated Rate |
$75,083.71 |
| Rate for Payer: Aetna Commercial |
$60,223.39
|
| Rate for Payer: Anthem Medicaid |
$26,897.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,005.52
|
| Rate for Payer: Cash Price |
$39,106.10
|
| Rate for Payer: Cigna Commercial |
$64,916.13
|
| Rate for Payer: First Health Commercial |
$74,301.59
|
| Rate for Payer: Humana Commercial |
$66,480.37
|
| Rate for Payer: Humana KY Medicaid |
$26,897.18
|
| Rate for Payer: Kentucky WC Medicaid |
$27,170.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,134.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,720.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,436.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,826.74
|
| Rate for Payer: Ohio Health Group HMO |
$58,659.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,044.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,966.42
|
| Rate for Payer: PHCS Commercial |
$75,083.71
|
| Rate for Payer: United Healthcare All Payer |
$68,826.74
|
|
|
SOL SYS FEM STEM 12/14 TPR STR
|
Facility
|
OP
|
$78,344.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,503.22 |
| Max. Negotiated Rate |
$75,210.30 |
| Rate for Payer: Aetna Commercial |
$60,324.93
|
| Rate for Payer: Anthem Medicaid |
$26,942.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,108.37
|
| Rate for Payer: Cash Price |
$39,172.03
|
| Rate for Payer: Cigna Commercial |
$65,025.57
|
| Rate for Payer: First Health Commercial |
$74,426.86
|
| Rate for Payer: Humana Commercial |
$66,592.45
|
| Rate for Payer: Humana KY Medicaid |
$26,942.52
|
| Rate for Payer: Kentucky WC Medicaid |
$27,216.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,242.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,817.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,503.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,483.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,942.77
|
| Rate for Payer: Ohio Health Group HMO |
$58,758.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,675.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,159.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,057.40
|
| Rate for Payer: PHCS Commercial |
$75,210.30
|
| Rate for Payer: United Healthcare All Payer |
$68,942.77
|
|
|
SOL SYS FEM STEM 12/14 TPR STR
|
Facility
|
IP
|
$78,344.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,503.22 |
| Max. Negotiated Rate |
$75,210.30 |
| Rate for Payer: Aetna Commercial |
$60,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,108.37
|
| Rate for Payer: Cash Price |
$39,172.03
|
| Rate for Payer: Cigna Commercial |
$65,025.57
|
| Rate for Payer: First Health Commercial |
$74,426.86
|
| Rate for Payer: Humana Commercial |
$66,592.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,242.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,817.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,503.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,942.77
|
| Rate for Payer: Ohio Health Group HMO |
$58,758.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,675.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,159.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,057.40
|
| Rate for Payer: PHCS Commercial |
$75,210.30
|
| Rate for Payer: United Healthcare All Payer |
$68,942.77
|
|
|
SOLU CORTEF 100MG(500MG/4ML)
|
Facility
|
OP
|
$356.44
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25003826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$342.18 |
| Rate for Payer: Aetna Commercial |
$274.46
|
| Rate for Payer: Anthem Medicaid |
$122.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.02
|
| Rate for Payer: Cash Price |
$178.22
|
| Rate for Payer: Cigna Commercial |
$295.85
|
| Rate for Payer: First Health Commercial |
$338.62
|
| Rate for Payer: Humana Commercial |
$302.97
|
| Rate for Payer: Humana KY Medicaid |
$122.58
|
| Rate for Payer: Kentucky WC Medicaid |
$123.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$313.67
|
| Rate for Payer: Ohio Health Group HMO |
$267.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.94
|
| Rate for Payer: PHCS Commercial |
$342.18
|
| Rate for Payer: United Healthcare All Payer |
$313.67
|
|
|
SOLU CORTEF 100MG(500MG/4ML)
|
Facility
|
IP
|
$356.44
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25003826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$342.18 |
| Rate for Payer: Aetna Commercial |
$274.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.02
|
| Rate for Payer: Cash Price |
$178.22
|
| Rate for Payer: Cigna Commercial |
$295.85
|
| Rate for Payer: First Health Commercial |
$338.62
|
| Rate for Payer: Humana Commercial |
$302.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$313.67
|
| Rate for Payer: Ohio Health Group HMO |
$267.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.94
|
| Rate for Payer: PHCS Commercial |
$342.18
|
| Rate for Payer: United Healthcare All Payer |
$313.67
|
|
|
SOLU CORTEF(HYDROCOR 100MG/2ML
|
Facility
|
IP
|
$131.07
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Aetna Commercial |
$100.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.23
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cigna Commercial |
$108.79
|
| Rate for Payer: First Health Commercial |
$124.52
|
| Rate for Payer: Humana Commercial |
$111.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.34
|
| Rate for Payer: Ohio Health Group HMO |
$98.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.44
|
| Rate for Payer: PHCS Commercial |
$125.83
|
| Rate for Payer: United Healthcare All Payer |
$115.34
|
|
|
SOLU CORTEF(HYDROCOR 100MG/2ML
|
Facility
|
OP
|
$131.07
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Aetna Commercial |
$100.92
|
| Rate for Payer: Anthem Medicaid |
$45.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.23
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cigna Commercial |
$108.79
|
| Rate for Payer: First Health Commercial |
$124.52
|
| Rate for Payer: Humana Commercial |
$111.41
|
| Rate for Payer: Humana KY Medicaid |
$45.07
|
| Rate for Payer: Kentucky WC Medicaid |
$45.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.34
|
| Rate for Payer: Ohio Health Group HMO |
$98.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.44
|
| Rate for Payer: PHCS Commercial |
$125.83
|
| Rate for Payer: United Healthcare All Payer |
$115.34
|
|
|
SOLU CORTEF(HYDROCOR 250MG/2ML
|
Facility
|
OP
|
$200.53
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$192.51 |
| Rate for Payer: Aetna Commercial |
$154.41
|
| Rate for Payer: Anthem Medicaid |
$68.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.41
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cigna Commercial |
$166.44
|
| Rate for Payer: First Health Commercial |
$190.50
|
| Rate for Payer: Humana Commercial |
$170.45
|
| Rate for Payer: Humana KY Medicaid |
$68.96
|
| Rate for Payer: Kentucky WC Medicaid |
$69.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.47
|
| Rate for Payer: Ohio Health Group HMO |
$150.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.37
|
| Rate for Payer: PHCS Commercial |
$192.51
|
| Rate for Payer: United Healthcare All Payer |
$176.47
|
|
|
SOLU CORTEF(HYDROCOR 250MG/2ML
|
Facility
|
IP
|
$200.53
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
25002156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$192.51 |
| Rate for Payer: Aetna Commercial |
$154.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.41
|
| Rate for Payer: Cash Price |
$100.26
|
| Rate for Payer: Cigna Commercial |
$166.44
|
| Rate for Payer: First Health Commercial |
$190.50
|
| Rate for Payer: Humana Commercial |
$170.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.47
|
| Rate for Payer: Ohio Health Group HMO |
$150.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.37
|
| Rate for Payer: PHCS Commercial |
$192.51
|
| Rate for Payer: United Healthcare All Payer |
$176.47
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
636T0061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Humana Medicare Advantage |
$0.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
OP
|
$116.74
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$58.37
|
| 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: Humana Medicare Advantage |
$0.26
|
| 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 |
$0.31
|
| 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 |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
IP
|
$116.74
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.02 |
| 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 |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Humana Medicare Advantage |
$0.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Professional
|
Both
|
$4.67
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Ambetter Exchange |
$0.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Multiplan PHCS |
$2.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.34
|
| Rate for Payer: UHCCP Medicaid |
$1.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.26
|
|
|
SOLU MEDROL 5MG(125MG/2ML)
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
636T0061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
SOLU-MEDROL 5MG (2GM SDV)
|
Facility
|
IP
|
$536.86
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.06 |
| 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 |
$429.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$370.43
|
| 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 |
$0.26 |
| Max. Negotiated Rate |
$515.39 |
| Rate for Payer: Aetna Commercial |
$413.38
|
| Rate for Payer: Anthem Medicaid |
$184.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$268.43
|
| 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: Humana Medicare Advantage |
$0.26
|
| 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 |
$0.31
|
| 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 |
$429.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$370.43
|
| Rate for Payer: PHCS Commercial |
$515.39
|
| Rate for Payer: United Healthcare All Payer |
$472.44
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
IP
|
$113.05
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.91 |
| 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 |
$33.91
|
| 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 |
$90.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.00
|
| Rate for Payer: PHCS Commercial |
$108.53
|
| Rate for Payer: United Healthcare All Payer |
$99.48
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
OP
|
$14.13
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Anthem Medicaid |
$4.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cigna Commercial |
$11.73
|
| Rate for Payer: First Health Commercial |
$13.42
|
| Rate for Payer: Humana Commercial |
$12.01
|
| Rate for Payer: Humana KY Medicaid |
$4.86
|
| Rate for Payer: Humana Medicare Advantage |
$0.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.43
|
| Rate for Payer: Ohio Health Group HMO |
$10.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.75
|
| Rate for Payer: PHCS Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Payer |
$12.43
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
IP
|
$14.13
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
636T0060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.02
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cigna Commercial |
$11.73
|
| Rate for Payer: First Health Commercial |
$13.42
|
| Rate for Payer: Humana Commercial |
$12.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.43
|
| Rate for Payer: Ohio Health Group HMO |
$10.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.75
|
| Rate for Payer: PHCS Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Payer |
$12.43
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Professional
|
Both
|
$14.13
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Ambetter Exchange |
$0.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Multiplan PHCS |
$8.48
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.34
|
| Rate for Payer: UHCCP Medicaid |
$4.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.26
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
IP
|
$14.13
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.02
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cigna Commercial |
$11.73
|
| Rate for Payer: First Health Commercial |
$13.42
|
| Rate for Payer: Humana Commercial |
$12.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.43
|
| Rate for Payer: Ohio Health Group HMO |
$10.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.75
|
| Rate for Payer: PHCS Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Payer |
$12.43
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
OP
|
$14.13
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
636T0060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna Commercial |
$10.88
|
| Rate for Payer: Anthem Medicaid |
$4.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cigna Commercial |
$11.73
|
| Rate for Payer: First Health Commercial |
$13.42
|
| Rate for Payer: Humana Commercial |
$12.01
|
| Rate for Payer: Humana KY Medicaid |
$4.86
|
| Rate for Payer: Humana Medicare Advantage |
$0.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.43
|
| Rate for Payer: Ohio Health Group HMO |
$10.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.75
|
| Rate for Payer: PHCS Commercial |
$13.56
|
| Rate for Payer: United Healthcare All Payer |
$12.43
|
|
|
SOLU MEDROL 5MG(40MG/1ML)
|
Facility
|
OP
|
$113.05
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
25002362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$108.53 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Anthem Medicaid |
$38.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$56.52
|
| 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: Humana Medicare Advantage |
$0.26
|
| 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 |
$0.31
|
| 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 |
$90.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.00
|
| Rate for Payer: PHCS Commercial |
$108.53
|
| Rate for Payer: United Healthcare All Payer |
$99.48
|
|
