|
DEUCE FEM SZ 7 RT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 7 RT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 8 LT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 8 LT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 8 RT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 8 RT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEVELOP COGNITIVE SKILL DRCT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
43000016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.64
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
DEVELOP COGNITIVE SKILL DRCT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
43000016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.64
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
51000046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
51000046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
51000046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$22.44
|
| Rate for Payer: Anthem Medicaid |
$32.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$206.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$17.52
|
| Rate for Payer: Healthspan PPO |
$21.03
|
| Rate for Payer: Humana Medicaid |
$32.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.83
|
| Rate for Payer: Molina Healthcare Passport |
$32.19
|
| Rate for Payer: Multiplan PHCS |
$123.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.20
|
| Rate for Payer: UHCCP Medicaid |
$72.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.51
|
|
|
DEVELOPMENTAL SCREEN W/SCOR(T
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
510T0046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVELOPMENTAL SCREEN W/SCOR(T
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
510T0046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVICE URO SHEATH SM INTERCONT
|
Facility
|
IP
|
$26.11
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna Commercial |
$20.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.37
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna Commercial |
$21.67
|
| Rate for Payer: First Health Commercial |
$24.80
|
| Rate for Payer: Humana Commercial |
$22.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.98
|
| Rate for Payer: Ohio Health Group HMO |
$19.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.09
|
| Rate for Payer: PHCS Commercial |
$25.07
|
| Rate for Payer: United Healthcare All Payer |
$22.98
|
|
|
DEVICE URO SHEATH SM INTERCONT
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna Commercial |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$8.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.37
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna Commercial |
$21.67
|
| Rate for Payer: First Health Commercial |
$24.80
|
| Rate for Payer: Humana Commercial |
$22.19
|
| Rate for Payer: Humana KY Medicaid |
$8.98
|
| Rate for Payer: Kentucky WC Medicaid |
$9.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.98
|
| Rate for Payer: Ohio Health Group HMO |
$19.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.09
|
| Rate for Payer: PHCS Commercial |
$25.07
|
| Rate for Payer: United Healthcare All Payer |
$22.98
|
|
|
DEV INTERROG REMOTE 1/2/MLT
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 93295
|
| Hospital Charge Code |
48000088
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna Commercial |
$109.32
|
| Rate for Payer: Anthem Medicaid |
$54.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.00
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$110.68
|
| Rate for Payer: Healthspan PPO |
$102.76
|
| Rate for Payer: Humana Medicaid |
$54.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.68
|
| Rate for Payer: Molina Healthcare Passport |
$54.59
|
| Rate for Payer: Multiplan PHCS |
$187.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.10
|
| Rate for Payer: UHCCP Medicaid |
$109.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.14
|
|
|
DEV INTERROG REMOTE 1/2/MLT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 93295
|
| Hospital Charge Code |
48000088
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem Medicaid |
$107.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Humana KY Medicaid |
$107.64
|
| Rate for Payer: Kentucky WC Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.03
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
DEV INTERROG REMOTE 1/2/MLT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 93295
|
| Hospital Charge Code |
48000088
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.03
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
DEXAMETHASONE
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.84
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.34
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
DEXAMETHASONE
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.34
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
DEXAMETHASONE
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$214.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Multiplan PHCS |
$128.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$149.80
|
| Rate for Payer: UHCCP Medicaid |
$74.90
|
|
|
DEXAMETHASONE 0.25mg(0.5mgTab)
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Humana KY Medicaid |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$0.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem Medicaid |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
|
|
DEXAMETHASONE 0.25mg(0.5mgTab)
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
OP
|
$77.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Anthem Medicaid |
$26.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.40
|
| Rate for Payer: Cash Price |
$38.72
|
| Rate for Payer: Cigna Commercial |
$64.27
|
| Rate for Payer: First Health Commercial |
$73.56
|
| Rate for Payer: Humana Commercial |
$65.82
|
| Rate for Payer: Humana KY Medicaid |
$26.63
|
| Rate for Payer: Kentucky WC Medicaid |
$26.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.14
|
| Rate for Payer: Ohio Health Group HMO |
$58.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.00
|
| Rate for Payer: PHCS Commercial |
$74.33
|
| Rate for Payer: United Healthcare All Payer |
$68.14
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636T0029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna Commercial |
$5.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.80
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cigna Commercial |
$6.18
|
| Rate for Payer: First Health Commercial |
$7.07
|
| Rate for Payer: Humana Commercial |
$6.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.55
|
| Rate for Payer: Ohio Health Group HMO |
$5.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.31
|
| Rate for Payer: PHCS Commercial |
$7.14
|
| Rate for Payer: United Healthcare All Payer |
$6.55
|
|
