|
DEPOMEDROL 1MG (40MG SDV)
|
Facility
|
IP
|
$116.64
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
25002006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$111.97 |
| Rate for Payer: Aetna Commercial |
$89.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.98
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cigna Commercial |
$96.81
|
| Rate for Payer: First Health Commercial |
$110.81
|
| Rate for Payer: Humana Commercial |
$99.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.64
|
| Rate for Payer: Ohio Health Group HMO |
$87.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.48
|
| Rate for Payer: PHCS Commercial |
$111.97
|
| Rate for Payer: United Healthcare All Payer |
$102.64
|
|
|
DEPOMEDROL 1MG (40MG SDV)
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Anthem Medicaid |
$1.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna Commercial |
$2.42
|
| Rate for Payer: First Health Commercial |
$2.77
|
| Rate for Payer: Humana Commercial |
$2.48
|
| Rate for Payer: Humana KY Medicaid |
$1.00
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.57
|
| Rate for Payer: Ohio Health Group HMO |
$2.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.01
|
| Rate for Payer: PHCS Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Payer |
$2.57
|
|
|
DEPOMEDROL 1MG (40MG SDV)
|
Facility
|
OP
|
$116.64
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
25002006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$111.97 |
| Rate for Payer: Aetna Commercial |
$89.81
|
| Rate for Payer: Anthem Medicaid |
$40.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cigna Commercial |
$96.81
|
| Rate for Payer: First Health Commercial |
$110.81
|
| Rate for Payer: Humana Commercial |
$99.14
|
| Rate for Payer: Humana KY Medicaid |
$40.11
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Kentucky WC Medicaid |
$40.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.64
|
| Rate for Payer: Ohio Health Group HMO |
$87.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.48
|
| Rate for Payer: PHCS Commercial |
$111.97
|
| Rate for Payer: United Healthcare All Payer |
$102.64
|
|
|
DEPOMEDROL 1MG (40MG SDV)
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
636T0025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.28
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna Commercial |
$2.42
|
| Rate for Payer: First Health Commercial |
$2.77
|
| Rate for Payer: Humana Commercial |
$2.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.57
|
| Rate for Payer: Ohio Health Group HMO |
$2.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.01
|
| Rate for Payer: PHCS Commercial |
$2.80
|
| Rate for Payer: United Healthcare All Payer |
$2.57
|
|
|
DEPOMEDROL 1MG (40MG SDV)
|
Professional
|
Both
|
$2.92
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Ambetter Exchange |
$0.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.12
|
| Rate for Payer: Multiplan PHCS |
$1.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$1.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.12
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Facility
|
OP
|
$123.32
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
25002007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Anthem Medicaid |
$42.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cigna Commercial |
$102.36
|
| Rate for Payer: First Health Commercial |
$117.15
|
| Rate for Payer: Humana Commercial |
$104.82
|
| Rate for Payer: Humana KY Medicaid |
$42.41
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Kentucky WC Medicaid |
$42.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.52
|
| Rate for Payer: Ohio Health Group HMO |
$92.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.09
|
| Rate for Payer: PHCS Commercial |
$118.39
|
| Rate for Payer: United Healthcare All Payer |
$108.52
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem Medicaid |
$0.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.28
|
| Rate for Payer: First Health Commercial |
$1.46
|
| Rate for Payer: Humana Commercial |
$1.31
|
| Rate for Payer: Humana KY Medicaid |
$0.53
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Kentucky WC Medicaid |
$0.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.06
|
| Rate for Payer: PHCS Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.20
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.28
|
| Rate for Payer: First Health Commercial |
$1.46
|
| Rate for Payer: Humana Commercial |
$1.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.06
|
| Rate for Payer: PHCS Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
636T0026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.20
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.28
|
| Rate for Payer: First Health Commercial |
$1.46
|
| Rate for Payer: Humana Commercial |
$1.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.06
|
| Rate for Payer: PHCS Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
636T0026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem Medicaid |
$0.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.16
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.28
|
| Rate for Payer: First Health Commercial |
$1.46
|
| Rate for Payer: Humana Commercial |
$1.31
|
| Rate for Payer: Humana KY Medicaid |
$0.53
|
| Rate for Payer: Humana Medicare Advantage |
$0.12
|
| Rate for Payer: Kentucky WC Medicaid |
$0.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.06
|
| Rate for Payer: PHCS Commercial |
$1.48
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Facility
|
IP
|
$123.32
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
25002007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.19
|
| Rate for Payer: Cash Price |
$61.66
|
| Rate for Payer: Cigna Commercial |
$102.36
|
| Rate for Payer: First Health Commercial |
$117.15
|
| Rate for Payer: Humana Commercial |
$104.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.52
|
| Rate for Payer: Ohio Health Group HMO |
$92.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.09
|
| Rate for Payer: PHCS Commercial |
$118.39
|
| Rate for Payer: United Healthcare All Payer |
$108.52
|
|
|
DEPOMEDROL 1MG (80MG SDV)
|
Professional
|
Both
|
$1.54
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Ambetter Exchange |
$0.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.14
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.12
|
| Rate for Payer: Multiplan PHCS |
$0.92
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.12
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Facility
|
IP
|
$321.63
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
25002010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$308.76 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.87
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: First Health Commercial |
$305.55
|
| Rate for Payer: Humana Commercial |
$273.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.03
|
| Rate for Payer: Ohio Health Group HMO |
$241.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.92
|
| Rate for Payer: PHCS Commercial |
$308.76
|
| Rate for Payer: United Healthcare All Payer |
$283.03
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Professional
|
Both
|
$2.14
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Healthspan PPO |
$0.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.81
|
| Rate for Payer: Multiplan PHCS |
$1.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.50
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
636T0027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Anthem Medicaid |
$0.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.67
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna Commercial |
$1.78
|
| Rate for Payer: First Health Commercial |
$2.03
|
| Rate for Payer: Humana Commercial |
$1.82
|
| Rate for Payer: Humana KY Medicaid |
$0.74
|
| Rate for Payer: Kentucky WC Medicaid |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.88
|
| Rate for Payer: Ohio Health Group HMO |
$1.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Payer |
$1.88
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Facility
|
OP
|
$321.63
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
25002010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$308.76 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Anthem Medicaid |
$110.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.87
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: First Health Commercial |
$305.55
|
| Rate for Payer: Humana Commercial |
$273.39
|
| Rate for Payer: Humana KY Medicaid |
$110.61
|
| Rate for Payer: Kentucky WC Medicaid |
$111.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.03
|
| Rate for Payer: Ohio Health Group HMO |
$241.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.92
|
| Rate for Payer: PHCS Commercial |
$308.76
|
| Rate for Payer: United Healthcare All Payer |
$283.03
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Anthem Medicaid |
$0.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.67
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna Commercial |
$1.78
|
| Rate for Payer: First Health Commercial |
$2.03
|
| Rate for Payer: Humana Commercial |
$1.82
|
| Rate for Payer: Humana KY Medicaid |
$0.74
|
| Rate for Payer: Kentucky WC Medicaid |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.88
|
| Rate for Payer: Ohio Health Group HMO |
$1.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Payer |
$1.88
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.67
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna Commercial |
$1.78
|
| Rate for Payer: First Health Commercial |
$2.03
|
| Rate for Payer: Humana Commercial |
$1.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.88
|
| Rate for Payer: Ohio Health Group HMO |
$1.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Payer |
$1.88
|
|
|
DEPOPROVERA(MEDRX150MG/1ML)1MG
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
636T0027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.67
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna Commercial |
$1.78
|
| Rate for Payer: First Health Commercial |
$2.03
|
| Rate for Payer: Humana Commercial |
$1.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.88
|
| Rate for Payer: Ohio Health Group HMO |
$1.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Payer |
$1.88
|
|
|
DEPOPROVERA SQ [1MG] 104MG SYR
|
Facility
|
OP
|
$321.63
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
25002008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$308.76 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Anthem Medicaid |
$110.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.87
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: First Health Commercial |
$305.55
|
| Rate for Payer: Humana Commercial |
$273.39
|
| Rate for Payer: Humana KY Medicaid |
$110.61
|
| Rate for Payer: Kentucky WC Medicaid |
$111.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.03
|
| Rate for Payer: Ohio Health Group HMO |
$241.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.92
|
| Rate for Payer: PHCS Commercial |
$308.76
|
| Rate for Payer: United Healthcare All Payer |
$283.03
|
|
|
DEPOPROVERA SQ [1MG] 104MG SYR
|
Facility
|
IP
|
$321.63
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
25002008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$308.76 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.87
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: First Health Commercial |
$305.55
|
| Rate for Payer: Humana Commercial |
$273.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.03
|
| Rate for Payer: Ohio Health Group HMO |
$241.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.92
|
| Rate for Payer: PHCS Commercial |
$308.76
|
| Rate for Payer: United Healthcare All Payer |
$283.03
|
|
|
DEPRESSION SCREEN ANNUAL 15MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
51000321
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
DEPRESSION SCREEN ANNUAL 15MIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
51000321
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
DEPRESSION SCREEN ANNUAL 15MIN
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
51000321
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Ambetter Exchange |
$8.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.21
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.51
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.06
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.51
|
|
|
DERIDE INFEC TISS<10% BODSURF
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
76100101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.87 |
| Max. Negotiated Rate |
$1,169.28 |
| Rate for Payer: Aetna Commercial |
$937.86
|
| Rate for Payer: Anthem Medicaid |
$418.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$1,010.94
|
| Rate for Payer: First Health Commercial |
$1,157.10
|
| Rate for Payer: Humana Commercial |
$1,035.30
|
| Rate for Payer: Humana KY Medicaid |
$418.87
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$423.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$898.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,071.84
|
| Rate for Payer: Ohio Health Group HMO |
$913.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.42
|
| Rate for Payer: PHCS Commercial |
$1,169.28
|
| Rate for Payer: United Healthcare All Payer |
$1,071.84
|
|
