|
DEB SUB MUSC FASC ABD WALL(T
|
Facility
|
OP
|
$4,424.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
761T0020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,327.20 |
| Max. Negotiated Rate |
$4,247.04 |
| Rate for Payer: Aetna Commercial |
$3,406.48
|
| Rate for Payer: Anthem Medicaid |
$1,521.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,450.72
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cigna Commercial |
$3,671.92
|
| Rate for Payer: First Health Commercial |
$4,202.80
|
| Rate for Payer: Humana Commercial |
$3,760.40
|
| Rate for Payer: Humana KY Medicaid |
$1,521.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,536.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,627.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,264.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,327.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,551.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,893.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,318.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,539.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,848.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.56
|
| Rate for Payer: PHCS Commercial |
$4,247.04
|
| Rate for Payer: United Healthcare All Payer |
$3,893.12
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
76100019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Aetna Commercial |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.18
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$689.73
|
| Rate for Payer: First Health Commercial |
$789.45
|
| Rate for Payer: Humana Commercial |
$706.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.28
|
| Rate for Payer: Ohio Health Group HMO |
$623.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.39
|
| Rate for Payer: PHCS Commercial |
$797.76
|
| Rate for Payer: United Healthcare All Payer |
$731.28
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
761P0019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.85 |
| Max. Negotiated Rate |
$861.74 |
| Rate for Payer: Aetna Commercial |
$861.74
|
| Rate for Payer: Ambetter Exchange |
$537.52
|
| Rate for Payer: Anthem Medicaid |
$422.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$537.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$537.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$645.02
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$816.94
|
| Rate for Payer: Healthspan PPO |
$689.04
|
| Rate for Payer: Humana Medicaid |
$422.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$741.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$537.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.23
|
| Rate for Payer: Molina Healthcare Passport |
$422.77
|
| Rate for Payer: Multiplan PHCS |
$498.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$698.78
|
| Rate for Payer: UHCCP Medicaid |
$290.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$427.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$537.52
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
76100019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Aetna Commercial |
$639.87
|
| Rate for Payer: Anthem Medicaid |
$285.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.18
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$689.73
|
| Rate for Payer: First Health Commercial |
$789.45
|
| Rate for Payer: Humana Commercial |
$706.35
|
| Rate for Payer: Humana KY Medicaid |
$285.78
|
| Rate for Payer: Kentucky WC Medicaid |
$288.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.28
|
| Rate for Payer: Ohio Health Group HMO |
$623.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.39
|
| Rate for Payer: PHCS Commercial |
$797.76
|
| Rate for Payer: United Healthcare All Payer |
$731.28
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
76100019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.85 |
| Max. Negotiated Rate |
$861.74 |
| Rate for Payer: Aetna Commercial |
$861.74
|
| Rate for Payer: Ambetter Exchange |
$537.52
|
| Rate for Payer: Anthem Medicaid |
$422.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$537.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$537.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$645.02
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$816.94
|
| Rate for Payer: Healthspan PPO |
$689.04
|
| Rate for Payer: Humana Medicaid |
$422.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$741.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$537.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.23
|
| Rate for Payer: Molina Healthcare Passport |
$422.77
|
| Rate for Payer: Multiplan PHCS |
$498.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$698.78
|
| Rate for Payer: UHCCP Medicaid |
$290.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$427.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$537.52
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$1,713.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$1,027.80 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Ambetter Exchange |
$57.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.46
|
| Rate for Payer: Anthem Medicaid |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.46
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$108.94
|
| Rate for Payer: Healthspan PPO |
$84.98
|
| Rate for Payer: Humana Medicaid |
$48.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare Passport |
$48.18
|
| Rate for Payer: Multiplan PHCS |
$1,027.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.17
|
| Rate for Payer: UHCCP Medicaid |
$31.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.05
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$1,363.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,308.48 |
| Rate for Payer: Aetna Commercial |
$1,049.51
|
| Rate for Payer: Anthem Medicaid |
$468.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Cigna Commercial |
$1,131.29
|
| Rate for Payer: First Health Commercial |
$1,294.85
|
| Rate for Payer: Humana Commercial |
$1,158.55
|
| Rate for Payer: Humana KY Medicaid |
$468.74
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$473.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.47
|
| Rate for Payer: PHCS Commercial |
$1,308.48
|
| Rate for Payer: United Healthcare All Payer |
$1,199.44
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$1,363.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.90 |
| Max. Negotiated Rate |
$1,308.48 |
| Rate for Payer: Aetna Commercial |
$1,049.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.14
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Cigna Commercial |
$1,131.29
|
| Rate for Payer: First Health Commercial |
$1,294.85
|
| Rate for Payer: Humana Commercial |
$1,158.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.47
|
| Rate for Payer: PHCS Commercial |
$1,308.48
|
| Rate for Payer: United Healthcare All Payer |
$1,199.44
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$1,713.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,644.48 |
| Rate for Payer: Aetna Commercial |
$1,319.01
|
| Rate for Payer: Anthem Medicaid |
$589.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$1,421.79
|
| Rate for Payer: First Health Commercial |
$1,627.35
|
| Rate for Payer: Humana Commercial |
$1,456.05
|
| Rate for Payer: Humana KY Medicaid |
$589.10
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$595.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,404.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,284.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,490.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.97
|
| Rate for Payer: PHCS Commercial |
$1,644.48
|
| Rate for Payer: United Healthcare All Payer |
$1,507.44
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$1,713.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.90 |
| Max. Negotiated Rate |
$1,644.48 |
| Rate for Payer: Aetna Commercial |
$1,319.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.14
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$1,421.79
|
| Rate for Payer: First Health Commercial |
$1,627.35
|
| Rate for Payer: Humana Commercial |
$1,456.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,404.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,284.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,490.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.97
|
| Rate for Payer: PHCS Commercial |
$1,644.48
|
| Rate for Payer: United Healthcare All Payer |
$1,507.44
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
761P0026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Ambetter Exchange |
$57.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.46
|
| Rate for Payer: Anthem Medicaid |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.46
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$108.94
|
| Rate for Payer: Healthspan PPO |
$84.98
|
| Rate for Payer: Humana Medicaid |
$48.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare Passport |
$48.18
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.17
|
| Rate for Payer: UHCCP Medicaid |
$31.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.05
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<(T
|
Facility
|
IP
|
$1,363.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
761T0026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.90 |
| Max. Negotiated Rate |
$1,308.48 |
| Rate for Payer: Aetna Commercial |
$1,049.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.14
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Cigna Commercial |
$1,131.29
|
| Rate for Payer: First Health Commercial |
$1,294.85
|
| Rate for Payer: Humana Commercial |
$1,158.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.47
|
| Rate for Payer: PHCS Commercial |
$1,308.48
|
| Rate for Payer: United Healthcare All Payer |
$1,199.44
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<(T
|
Facility
|
OP
|
$1,363.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
761T0026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,308.48 |
| Rate for Payer: Aetna Commercial |
$1,049.51
|
| Rate for Payer: Anthem Medicaid |
$468.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Cash Price |
$681.50
|
| Rate for Payer: Cigna Commercial |
$1,131.29
|
| Rate for Payer: First Health Commercial |
$1,294.85
|
| Rate for Payer: Humana Commercial |
$1,158.55
|
| Rate for Payer: Humana KY Medicaid |
$468.74
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$473.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.47
|
| Rate for Payer: PHCS Commercial |
$1,308.48
|
| Rate for Payer: United Healthcare All Payer |
$1,199.44
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Professional
|
Both
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Ambetter Exchange |
$0.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Healthspan PPO |
$0.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Multiplan PHCS |
$2.62
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.03
|
| Rate for Payer: UHCCP Medicaid |
$1.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.02
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
636T0078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
636T0078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA 4MG/1TAB)
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
DECADRON 0.25MG(DEXA 4MG/1TAB)
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
DECADRON 1MG (20MG VIAL)
|
Facility
|
IP
|
$77.95
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Aetna Commercial |
$60.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.80
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cigna Commercial |
$64.70
|
| Rate for Payer: First Health Commercial |
$74.05
|
| Rate for Payer: Humana Commercial |
$66.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.60
|
| Rate for Payer: Ohio Health Group HMO |
$58.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.79
|
| Rate for Payer: PHCS Commercial |
$74.83
|
| Rate for Payer: United Healthcare All Payer |
$68.60
|
|
|
DECADRON 1MG (20MG VIAL)
|
Facility
|
OP
|
$77.95
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Aetna Commercial |
$60.02
|
| Rate for Payer: Anthem Medicaid |
$26.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.80
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cigna Commercial |
$64.70
|
| Rate for Payer: First Health Commercial |
$74.05
|
| Rate for Payer: Humana Commercial |
$66.26
|
| Rate for Payer: Humana KY Medicaid |
$26.81
|
| Rate for Payer: Kentucky WC Medicaid |
$27.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.60
|
| Rate for Payer: Ohio Health Group HMO |
$58.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.79
|
| Rate for Payer: PHCS Commercial |
$74.83
|
| Rate for Payer: United Healthcare All Payer |
$68.60
|
|
|
DECADRON 1MG TABLET
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
