|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
51000046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVELOPMENTAL SCREEN W/SCOR(T
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
510T0046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVELOPMENTAL SCREEN W/SCOR(T
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
510T0046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVICE URO SHEATH SM INTERCONT
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna Commercial |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$8.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.37
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna Commercial |
$21.67
|
| Rate for Payer: First Health Commercial |
$24.80
|
| Rate for Payer: Humana Commercial |
$22.19
|
| Rate for Payer: Humana KY Medicaid |
$8.98
|
| Rate for Payer: Kentucky WC Medicaid |
$9.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.98
|
| Rate for Payer: Ohio Health Group HMO |
$19.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.02
|
| Rate for Payer: PHCS Commercial |
$25.07
|
| Rate for Payer: United Healthcare All Payer |
$22.98
|
|
|
DEVICE URO SHEATH SM INTERCONT
|
Facility
|
IP
|
$26.11
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna Commercial |
$20.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.37
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna Commercial |
$21.67
|
| Rate for Payer: First Health Commercial |
$24.80
|
| Rate for Payer: Humana Commercial |
$22.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.98
|
| Rate for Payer: Ohio Health Group HMO |
$19.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.02
|
| Rate for Payer: PHCS Commercial |
$25.07
|
| Rate for Payer: United Healthcare All Payer |
$22.98
|
|
|
DEV INTERROG REMOTE 1/2/MLT
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 93295
|
| Hospital Charge Code |
48000088
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$187.80 |
| Rate for Payer: Aetna Commercial |
$109.32
|
| Rate for Payer: Ambetter Exchange |
$33.82
|
| Rate for Payer: Anthem Medicaid |
$54.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.58
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$110.68
|
| Rate for Payer: Healthspan PPO |
$102.76
|
| Rate for Payer: Humana Medicaid |
$54.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.68
|
| Rate for Payer: Molina Healthcare Passport |
$54.59
|
| Rate for Payer: Multiplan PHCS |
$187.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.97
|
| Rate for Payer: UHCCP Medicaid |
$109.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.82
|
|
|
DEV INTERROG REMOTE 1/2/MLT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 93295
|
| Hospital Charge Code |
48000088
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.97
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
DEV INTERROG REMOTE 1/2/MLT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 93295
|
| Hospital Charge Code |
48000088
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem Medicaid |
$107.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Humana KY Medicaid |
$107.64
|
| Rate for Payer: Kentucky WC Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.97
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
DEXAMETHASONE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
DEXAMETHASONE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$78.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$78.07
|
| Rate for Payer: Kentucky WC Medicaid |
$78.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
DEXAMETHASONE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
DEXAMETHASONE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
DEXAMETHASONE
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
30001809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Multiplan PHCS |
$136.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.90
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
|
|
DEXAMETHASONE 0.25mg(0.5mgTab)
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.64
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
DEXAMETHASONE 0.25mg(0.5mgTab)
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem Medicaid |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Humana KY Medicaid |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$0.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.64
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
OP
|
$77.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Anthem Medicaid |
$26.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.40
|
| Rate for Payer: Cash Price |
$38.72
|
| Rate for Payer: Cigna Commercial |
$64.27
|
| Rate for Payer: First Health Commercial |
$73.56
|
| Rate for Payer: Humana Commercial |
$65.82
|
| Rate for Payer: Humana KY Medicaid |
$26.63
|
| Rate for Payer: Kentucky WC Medicaid |
$26.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.14
|
| Rate for Payer: Ohio Health Group HMO |
$58.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.43
|
| Rate for Payer: PHCS Commercial |
$74.33
|
| Rate for Payer: United Healthcare All Payer |
$68.14
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.04
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna Commercial |
$6.42
|
| Rate for Payer: First Health Commercial |
$7.35
|
| Rate for Payer: Humana Commercial |
$6.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.81
|
| Rate for Payer: Ohio Health Group HMO |
$5.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.34
|
| Rate for Payer: PHCS Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Payer |
$6.81
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
IP
|
$77.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.23 |
| 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 |
$61.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.43
|
| Rate for Payer: PHCS Commercial |
$74.33
|
| Rate for Payer: United Healthcare All Payer |
$68.14
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
OP
|
$7.74
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636T0029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Anthem Medicaid |
$2.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.04
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna Commercial |
$6.42
|
| Rate for Payer: First Health Commercial |
$7.35
|
| Rate for Payer: Humana Commercial |
$6.58
|
| Rate for Payer: Humana KY Medicaid |
$2.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.81
|
| Rate for Payer: Ohio Health Group HMO |
$5.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.34
|
| Rate for Payer: PHCS Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Payer |
$6.81
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Professional
|
Both
|
$7.74
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| 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 |
$3.87
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Healthspan PPO |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.23
|
| 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 |
$4.64
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.12
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
OP
|
$7.74
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Anthem Medicaid |
$2.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.04
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna Commercial |
$6.42
|
| Rate for Payer: First Health Commercial |
$7.35
|
| Rate for Payer: Humana Commercial |
$6.58
|
| Rate for Payer: Humana KY Medicaid |
$2.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.81
|
| Rate for Payer: Ohio Health Group HMO |
$5.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.34
|
| Rate for Payer: PHCS Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Payer |
$6.81
|
|
|
DEXAMETHASONE 1MG(10MG/1ML)INJ
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636T0029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.04
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Cigna Commercial |
$6.42
|
| Rate for Payer: First Health Commercial |
$7.35
|
| Rate for Payer: Humana Commercial |
$6.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.81
|
| Rate for Payer: Ohio Health Group HMO |
$5.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.34
|
| Rate for Payer: PHCS Commercial |
$7.43
|
| Rate for Payer: United Healthcare All Payer |
$6.81
|
|
|
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 |
$1.50 |
| 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 |
$4.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
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 |
$1.50 |
| 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 |
$4.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
DEXAMETHASONE 1MG [4MG/1ML]
|
Professional
|
Both
|
$15.95
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| 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 |
$7.97
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Healthspan PPO |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.23
|
| 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 |
$9.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$5.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.12
|
|
