|
PREDNISONE 10MG (10MG/1 TAB)
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
PREDNISONE 1 MG TABLE 1MG/1TAB
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002498
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
PREDNISONE 1 MG TABLE 1MG/1TAB
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002498
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
PREDNISONE 20MG (20MG/1 TAB)
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
PREDNISONE 20MG (20MG/1 TAB)
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
PREDNISONE 2.5 MG T 2.5MG/1TAB
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
PREDNISONE 2.5 MG T 2.5MG/1TAB
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
PREDNISONE 5 MG TAB 5MG/1TAB
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
|
|
PREDNISONE 5 MG TAB 5MG/1TAB
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
PREGNANCY FIRST TRIMESTER
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$602.88 |
| Rate for Payer: Aetna Commercial |
$483.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.84
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$521.24
|
| Rate for Payer: First Health Commercial |
$596.60
|
| Rate for Payer: Humana Commercial |
$533.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$463.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$552.64
|
| Rate for Payer: Ohio Health Group HMO |
$471.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.68
|
| Rate for Payer: PHCS Commercial |
$602.88
|
| Rate for Payer: United Healthcare All Payer |
$552.64
|
|
|
PREGNANCY FIRST TRIMESTER
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$602.88 |
| Rate for Payer: Aetna Commercial |
$483.56
|
| Rate for Payer: Anthem Medicaid |
$215.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$521.24
|
| Rate for Payer: First Health Commercial |
$596.60
|
| Rate for Payer: Humana Commercial |
$533.80
|
| Rate for Payer: Humana KY Medicaid |
$215.97
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$218.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$463.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$220.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$552.64
|
| Rate for Payer: Ohio Health Group HMO |
$471.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.68
|
| Rate for Payer: PHCS Commercial |
$602.88
|
| Rate for Payer: United Healthcare All Payer |
$552.64
|
|
|
PREGNANCY FIRST TRIMESTER
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Anthem Medicaid |
$68.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$628.00
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$195.61
|
| Rate for Payer: Healthspan PPO |
$188.10
|
| Rate for Payer: Humana Medicaid |
$68.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.47
|
| Rate for Payer: Molina Healthcare Passport |
$68.11
|
| Rate for Payer: Multiplan PHCS |
$376.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$439.60
|
| Rate for Payer: UHCCP Medicaid |
$219.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.79
|
|
|
PREGNANCY FIRST TRIMESTER(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
402P0031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$200.74 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Anthem Medicaid |
$68.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$195.61
|
| Rate for Payer: Healthspan PPO |
$188.10
|
| Rate for Payer: Humana Medicaid |
$68.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.47
|
| Rate for Payer: Molina Healthcare Passport |
$68.11
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.79
|
|
|
PREGNANCY FIRST TRIMESTER(T
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
402T0031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$482.88 |
| Rate for Payer: Aetna Commercial |
$387.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.34
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cigna Commercial |
$417.49
|
| Rate for Payer: First Health Commercial |
$477.85
|
| Rate for Payer: Humana Commercial |
$427.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$412.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$442.64
|
| Rate for Payer: Ohio Health Group HMO |
$377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.93
|
| Rate for Payer: PHCS Commercial |
$482.88
|
| Rate for Payer: United Healthcare All Payer |
$442.64
|
|
|
PREGNANCY FIRST TRIMESTER(T
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
402T0031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$482.88 |
| Rate for Payer: Aetna Commercial |
$387.31
|
| Rate for Payer: Anthem Medicaid |
$172.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cigna Commercial |
$417.49
|
| Rate for Payer: First Health Commercial |
$477.85
|
| Rate for Payer: Humana Commercial |
$427.55
|
| Rate for Payer: Humana KY Medicaid |
$172.98
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$174.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$412.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$442.64
|
| Rate for Payer: Ohio Health Group HMO |
$377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.93
|
| Rate for Payer: PHCS Commercial |
$482.88
|
| Rate for Payer: United Healthcare All Payer |
$442.64
|
|
|
PREGNANCY TRANSVAG
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$114.01 |
| Max. Negotiated Rate |
$841.92 |
| Rate for Payer: Aetna Commercial |
$675.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.06
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$727.91
|
| Rate for Payer: First Health Commercial |
$833.15
|
| Rate for Payer: Humana Commercial |
$745.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$771.76
|
| Rate for Payer: Ohio Health Group HMO |
$657.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.87
|
| Rate for Payer: PHCS Commercial |
$841.92
|
| Rate for Payer: United Healthcare All Payer |
$771.76
|
|
|
PREGNANCY TRANSVAG
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$841.92 |
| Rate for Payer: Aetna Commercial |
$675.29
|
| Rate for Payer: Anthem Medicaid |
$301.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$727.91
|
| Rate for Payer: First Health Commercial |
$833.15
|
| Rate for Payer: Humana Commercial |
$745.45
|
| Rate for Payer: Humana KY Medicaid |
$301.60
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$304.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$771.76
|
| Rate for Payer: Ohio Health Group HMO |
$657.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.87
|
| Rate for Payer: PHCS Commercial |
$841.92
|
| Rate for Payer: United Healthcare All Payer |
$771.76
|
|
|
PREGNANCY TRANSVAG
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$877.00 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.00
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$145.01
|
| Rate for Payer: Healthspan PPO |
$142.86
|
| Rate for Payer: Humana Medicaid |
$71.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.34
|
| Rate for Payer: Molina Healthcare Passport |
$71.90
|
| Rate for Payer: Multiplan PHCS |
$526.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$613.90
|
| Rate for Payer: UHCCP Medicaid |
$306.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
|
|
PREGNANCY TRANSVAG(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402P0039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$145.01
|
| Rate for Payer: Healthspan PPO |
$142.86
|
| Rate for Payer: Humana Medicaid |
$71.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.34
|
| Rate for Payer: Molina Healthcare Passport |
$71.90
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
|
|
PREGNANCY TRANSVAG(T
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
PREGNANCY TRANSVAG(T
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$267.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Humana KY Medicaid |
$267.21
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$269.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
PREG TEST BLOOD QUANTITATIVE
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
30000560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem Medicaid |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Humana KY Medicaid |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Kentucky WC Medicaid |
$15.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.37
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
PREG TEST BLOOD QUANTITATIVE
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
30000560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.98
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.37
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
PRE HYDR EVANS WEDGE 12MM
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRE HYDR EVANS WEDGE 12MM
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
