|
PRECOSE (ACARBOSE) 5 50MG/1TAB
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 64380075906
|
| Hospital Charge Code |
25001212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
PRED FORTE (PREDNISOLONE)O 5ML
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
25001213
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem Medicaid |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Humana KY Medicaid |
$0.67
|
| Rate for Payer: Kentucky WC Medicaid |
$0.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
PRED FORTE (PREDNISOLONE)O 5ML
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
25001213
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
PREDNISONE 10MG (10MG/1 TAB)
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| 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: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| 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: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
PREDNISONE 10MG (10MG/1 TAB)
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| 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 |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
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 |
$1.33 |
| 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 |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
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 |
$1.33 |
| 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 |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
PREDNISONE 20MG (20MG/1 TAB)
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
PREDNISONE 20MG (20MG/1 TAB)
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| 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
|
OP
|
$4.35
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| 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 |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| 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
|
IP
|
$4.35
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
25002500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| 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 |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
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 |
$1.32 |
| 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 |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
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 |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| 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
|
| 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 |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
PREGNANCY FIRST TRIMESTER
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$634.56 |
| Rate for Payer: Aetna Commercial |
$508.97
|
| Rate for Payer: Anthem Medicaid |
$227.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$515.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cigna Commercial |
$548.63
|
| Rate for Payer: First Health Commercial |
$627.95
|
| Rate for Payer: Humana Commercial |
$561.85
|
| Rate for Payer: Humana KY Medicaid |
$227.32
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$229.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$581.68
|
| Rate for Payer: Ohio Health Group HMO |
$495.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.09
|
| Rate for Payer: PHCS Commercial |
$634.56
|
| Rate for Payer: United Healthcare All Payer |
$581.68
|
|
|
PREGNANCY FIRST TRIMESTER
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$396.60 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Ambetter Exchange |
$105.89
|
| Rate for Payer: Anthem Medicaid |
$68.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.07
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cash Price |
$330.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$105.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.47
|
| Rate for Payer: Molina Healthcare Passport |
$68.11
|
| Rate for Payer: Multiplan PHCS |
$396.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.66
|
| Rate for Payer: UHCCP Medicaid |
$231.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.89
|
|
|
PREGNANCY FIRST TRIMESTER
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$634.56 |
| Rate for Payer: Aetna Commercial |
$508.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$515.58
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cigna Commercial |
$548.63
|
| Rate for Payer: First Health Commercial |
$627.95
|
| Rate for Payer: Humana Commercial |
$561.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$581.68
|
| Rate for Payer: Ohio Health Group HMO |
$495.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.09
|
| Rate for Payer: PHCS Commercial |
$634.56
|
| Rate for Payer: United Healthcare All Payer |
$581.68
|
|
|
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: Ambetter Exchange |
$105.89
|
| Rate for Payer: Anthem Medicaid |
$68.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.07
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$105.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.89
|
| 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 |
$137.66
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.89
|
|
|
PREGNANCY FIRST TRIMESTER(T
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
402T0031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem Medicaid |
$184.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Humana KY Medicaid |
$184.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$186.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
PREGNANCY FIRST TRIMESTER(T
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
402T0031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
PREGNANCY TRANSVAG
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Ambetter Exchange |
$83.35
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.02
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.34
|
| Rate for Payer: Molina Healthcare Passport |
$71.90
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.36
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.35
|
|
|
PREGNANCY TRANSVAG
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
PREGNANCY TRANSVAG
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
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: Ambetter Exchange |
$83.35
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.35
|
| 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 |
$108.36
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.35
|
|
|
PREGNANCY TRANSVAG(T
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$793.92 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem Medicaid |
$284.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Humana KY Medicaid |
$284.41
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.63
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
|
PREGNANCY TRANSVAG(T
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0039
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$248.10 |
| Max. Negotiated Rate |
$793.92 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.63
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
