|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600029
|
|
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 Medicaid |
$2.56
|
| 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: Humana KY Medicaid |
$2.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2.58
|
| 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: Molina Healthcare Medicaid |
$2.61
|
| 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
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
IP
|
$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 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: 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: 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
|
OP
|
$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 Medicaid |
$2.56
|
| 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: Humana KY Medicaid |
$2.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2.58
|
| 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: Molina Healthcare Medicaid |
$2.61
|
| 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
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Professional
|
Both
|
$7.44
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.44
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Healthspan PPO |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.23
|
| Rate for Payer: Multiplan PHCS |
$4.46
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.21
|
| Rate for Payer: UHCCP Medicaid |
$2.60
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600029
|
|
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
|
|
|
DEXAMETHASONE[1 MG ]10MG/2.5ML
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
DEXAMETHASONE[1 MG ]10MG/2.5ML
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Professional
|
Both
|
$15.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.20
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Healthspan PPO |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.23
|
| Rate for Payer: Multiplan PHCS |
$9.12
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.64
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636T0030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.86
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cigna Commercial |
$12.62
|
| Rate for Payer: First Health Commercial |
$14.44
|
| Rate for Payer: Humana Commercial |
$12.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.38
|
| Rate for Payer: Ohio Health Group HMO |
$11.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.71
|
| Rate for Payer: PHCS Commercial |
$14.59
|
| Rate for Payer: United Healthcare All Payer |
$13.38
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Facility
|
IP
|
$63.78
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$61.23 |
| Rate for Payer: Aetna Commercial |
$49.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.75
|
| Rate for Payer: Cash Price |
$31.89
|
| Rate for Payer: Cigna Commercial |
$52.94
|
| Rate for Payer: First Health Commercial |
$60.59
|
| Rate for Payer: Humana Commercial |
$54.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.13
|
| Rate for Payer: Ohio Health Group HMO |
$47.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.77
|
| Rate for Payer: PHCS Commercial |
$61.23
|
| Rate for Payer: United Healthcare All Payer |
$56.13
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.86
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cigna Commercial |
$12.62
|
| Rate for Payer: First Health Commercial |
$14.44
|
| Rate for Payer: Humana Commercial |
$12.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.38
|
| Rate for Payer: Ohio Health Group HMO |
$11.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.71
|
| Rate for Payer: PHCS Commercial |
$14.59
|
| Rate for Payer: United Healthcare All Payer |
$13.38
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Facility
|
OP
|
$63.78
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$61.23 |
| Rate for Payer: Kentucky WC Medicaid |
$22.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.13
|
| Rate for Payer: Ohio Health Group HMO |
$47.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.77
|
| Rate for Payer: PHCS Commercial |
$61.23
|
| Rate for Payer: United Healthcare All Payer |
$56.13
|
| Rate for Payer: Aetna Commercial |
$49.11
|
| Rate for Payer: Anthem Medicaid |
$21.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.75
|
| Rate for Payer: Cash Price |
$31.89
|
| Rate for Payer: Cigna Commercial |
$52.94
|
| Rate for Payer: First Health Commercial |
$60.59
|
| Rate for Payer: Humana Commercial |
$54.21
|
| Rate for Payer: Humana KY Medicaid |
$21.93
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Anthem Medicaid |
$5.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.86
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cigna Commercial |
$12.62
|
| Rate for Payer: First Health Commercial |
$14.44
|
| Rate for Payer: Humana Commercial |
$12.92
|
| Rate for Payer: Humana KY Medicaid |
$5.23
|
| Rate for Payer: Kentucky WC Medicaid |
$5.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.38
|
| Rate for Payer: Ohio Health Group HMO |
$11.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.71
|
| Rate for Payer: PHCS Commercial |
$14.59
|
| Rate for Payer: United Healthcare All Payer |
$13.38
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636T0030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Anthem Medicaid |
$5.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.86
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cigna Commercial |
$12.62
|
| Rate for Payer: First Health Commercial |
$14.44
|
| Rate for Payer: Humana Commercial |
$12.92
|
| Rate for Payer: Humana KY Medicaid |
$5.23
|
| Rate for Payer: Kentucky WC Medicaid |
$5.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.38
|
| Rate for Payer: Ohio Health Group HMO |
$11.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.71
|
| Rate for Payer: PHCS Commercial |
$14.59
|
| Rate for Payer: United Healthcare All Payer |
$13.38
|
|
|
DEXILANT 60 MG CAPSULE
|
Facility
|
OP
|
$27.28
|
|
|
Service Code
|
NDC 64764017590
|
| Hospital Charge Code |
25000548
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Anthem Medicaid |
$9.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.28
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cigna Commercial |
$22.64
|
| Rate for Payer: First Health Commercial |
$25.92
|
| Rate for Payer: Humana Commercial |
$23.19
|
| Rate for Payer: Humana KY Medicaid |
$9.38
|
| Rate for Payer: Kentucky WC Medicaid |
$9.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.01
|
| Rate for Payer: Ohio Health Group HMO |
$20.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.46
|
| Rate for Payer: PHCS Commercial |
$26.19
|
| Rate for Payer: United Healthcare All Payer |
$24.01
|
|
|
DEXILANT 60 MG CAPSULE
|
Facility
|
IP
|
$27.28
|
|
|
Service Code
|
NDC 64764017590
|
| Hospital Charge Code |
25000548
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.28
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cigna Commercial |
$22.64
|
| Rate for Payer: First Health Commercial |
$25.92
|
| Rate for Payer: Humana Commercial |
$23.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.01
|
| Rate for Payer: Ohio Health Group HMO |
$20.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.46
|
| Rate for Payer: PHCS Commercial |
$26.19
|
| Rate for Payer: United Healthcare All Payer |
$24.01
|
|
|
DEXMEDETOMIDINE 80mcg/20mL SDV
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.96
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
DEXMEDETOMIDINE 80mcg/20mL SDV
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$62.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.96
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$62.59
|
| Rate for Payer: Kentucky WC Medicaid |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
DEXTROS5%NACL4.45%KCL20MEQ1000
|
Facility
|
IP
|
$114.07
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$109.51 |
| Rate for Payer: Aetna Commercial |
$87.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.97
|
| Rate for Payer: Cash Price |
$57.03
|
| Rate for Payer: Cigna Commercial |
$94.68
|
| Rate for Payer: First Health Commercial |
$108.37
|
| Rate for Payer: Humana Commercial |
$96.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.38
|
| Rate for Payer: Ohio Health Group HMO |
$85.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.36
|
| Rate for Payer: PHCS Commercial |
$109.51
|
| Rate for Payer: United Healthcare All Payer |
$100.38
|
|
|
DEXTROS5%NACL4.45%KCL20MEQ1000
|
Facility
|
OP
|
$114.07
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002992
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$109.51 |
| Rate for Payer: Aetna Commercial |
$87.83
|
| Rate for Payer: Anthem Medicaid |
$39.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.97
|
| Rate for Payer: Cash Price |
$57.03
|
| Rate for Payer: Cigna Commercial |
$94.68
|
| Rate for Payer: First Health Commercial |
$108.37
|
| Rate for Payer: Humana Commercial |
$96.96
|
| Rate for Payer: Humana KY Medicaid |
$39.23
|
| Rate for Payer: Kentucky WC Medicaid |
$39.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.38
|
| Rate for Payer: Ohio Health Group HMO |
$85.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.36
|
| Rate for Payer: PHCS Commercial |
$109.51
|
| Rate for Payer: United Healthcare All Payer |
$100.38
|
|
|
DEXTROSE 10% 25GM/250ML BAG
|
Facility
|
IP
|
$112.25
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
DEXTROSE 10% 25GM/250ML BAG
|
Facility
|
OP
|
$112.25
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem Medicaid |
$38.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Humana KY Medicaid |
$38.60
|
| Rate for Payer: Kentucky WC Medicaid |
$39.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
DEXTROSE 10% 500ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
NDC 990793003
|
| Hospital Charge Code |
25004235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
DEXTROSE 10% 500ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
NDC 990793003
|
| Hospital Charge Code |
25004235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem Medicaid |
$32.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Humana KY Medicaid |
$32.41
|
| Rate for Payer: Kentucky WC Medicaid |
$32.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
DEXTROSE 10% (FS) 1000ML
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
NDC 990793009
|
| Hospital Charge Code |
25002993
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem Medicaid |
$1.81
|
| Rate for Payer: Anthem Medicaid |
$32.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: Cigna Commercial |
$4.36
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: First Health Commercial |
$4.99
|
| Rate for Payer: Humana Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Humana KY Medicaid |
$1.81
|
| Rate for Payer: Humana KY Medicaid |
$32.41
|
| Rate for Payer: Kentucky WC Medicaid |
$32.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$3.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: PHCS Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
| Rate for Payer: United Healthcare All Payer |
$4.62
|
|
