|
TX INT/PR/SUBTRCHNTRC FEM FX
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
76100794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.00 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Anthem Medicaid |
$921.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,560.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$1,883.32
|
| Rate for Payer: Healthspan PPO |
$1,651.29
|
| Rate for Payer: Humana Medicaid |
$921.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$940.38
|
| Rate for Payer: Molina Healthcare Passport |
$921.94
|
| Rate for Payer: Multiplan PHCS |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,792.00
|
| Rate for Payer: UHCCP Medicaid |
$896.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$931.16
|
|
|
TX INT/PR/SUBTRCHNTRC FEM FX
|
Facility
|
IP
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
76100794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$2,457.60 |
| Rate for Payer: Aetna Commercial |
$1,971.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,996.80
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$2,124.80
|
| Rate for Payer: First Health Commercial |
$2,432.00
|
| Rate for Payer: Humana Commercial |
$2,176.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,099.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,889.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$768.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,252.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.60
|
| Rate for Payer: PHCS Commercial |
$2,457.60
|
| Rate for Payer: United Healthcare All Payer |
$2,252.80
|
|
|
TX INT/PR/SUBTRCHNTRC FEM FX(P
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
761P0794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.00 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Anthem Medicaid |
$921.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,560.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$1,883.32
|
| Rate for Payer: Healthspan PPO |
$1,651.29
|
| Rate for Payer: Humana Medicaid |
$921.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$940.38
|
| Rate for Payer: Molina Healthcare Passport |
$921.94
|
| Rate for Payer: Multiplan PHCS |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,792.00
|
| Rate for Payer: UHCCP Medicaid |
$896.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$931.16
|
|
|
TX MISSED ABORT 1ST TRIMESTE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
720P0028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$200.62 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$552.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.62
|
| Rate for Payer: Anthem Medicaid |
$228.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$510.03
|
| Rate for Payer: Healthspan PPO |
$428.33
|
| Rate for Payer: Humana Medicaid |
$228.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.31
|
| Rate for Payer: Molina Healthcare Passport |
$228.74
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$210.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.03
|
|
|
TX MISSED ABORT 1ST TRIMESTER
|
Facility
|
IP
|
$6,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
72000028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$788.97 |
| Max. Negotiated Rate |
$5,826.24 |
| Rate for Payer: Aetna Commercial |
$4,673.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,733.82
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cigna Commercial |
$5,037.27
|
| Rate for Payer: First Health Commercial |
$5,765.55
|
| Rate for Payer: Humana Commercial |
$5,158.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,976.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,478.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,820.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,340.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,551.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,213.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$788.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,881.39
|
| Rate for Payer: PHCS Commercial |
$5,826.24
|
| Rate for Payer: United Healthcare All Payer |
$5,340.72
|
|
|
TX MISSED ABORT 1ST TRIMESTER
|
Facility
|
OP
|
$6,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
72000028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$788.97 |
| Max. Negotiated Rate |
$5,826.24 |
| Rate for Payer: Aetna Commercial |
$4,673.13
|
| Rate for Payer: Anthem Medicaid |
$2,087.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,733.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cigna Commercial |
$5,037.27
|
| Rate for Payer: First Health Commercial |
$5,765.55
|
| Rate for Payer: Humana Commercial |
$5,158.65
|
| Rate for Payer: Humana KY Medicaid |
$2,087.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,108.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,976.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,478.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,129.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,340.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,551.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,213.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$788.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,881.39
|
| Rate for Payer: PHCS Commercial |
$5,826.24
|
| Rate for Payer: United Healthcare All Payer |
$5,340.72
|
|
|
TX MISSED ABORT 1ST TRIMESTER
|
Professional
|
Both
|
$6,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
72000028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$200.62 |
| Max. Negotiated Rate |
$6,069.00 |
| Rate for Payer: Aetna Commercial |
$552.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.62
|
| Rate for Payer: Anthem Medicaid |
$228.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,069.00
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cigna Commercial |
$510.03
|
| Rate for Payer: Healthspan PPO |
$428.33
|
| Rate for Payer: Humana Medicaid |
$228.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.31
|
| Rate for Payer: Molina Healthcare Passport |
$228.74
|
| Rate for Payer: Multiplan PHCS |
$3,641.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,248.30
|
| Rate for Payer: UHCCP Medicaid |
$210.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.03
|
|
|
TX MISSED ABORT 1ST TRIMESTE(T
|
Facility
|
OP
|
$5,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
720T0028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$658.97 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem Medicaid |
$1,743.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Humana KY Medicaid |
$1,743.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,013.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,571.39
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TX MISSED ABORT 1ST TRIMESTE(T
|
Facility
|
IP
|
$5,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
720T0028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$658.97 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,013.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,571.39
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TX MISSED ABORT 2ND TRIMESTE(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
720P0029
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$194.66 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$564.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$194.66
|
| Rate for Payer: Anthem Medicaid |
$213.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$521.41
|
| Rate for Payer: Healthspan PPO |
$438.90
|
| Rate for Payer: Humana Medicaid |
$213.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.28
|
| Rate for Payer: Molina Healthcare Passport |
$213.02
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$204.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.15
|
|
|
TX MISSED ABORT 2ND TRIMESTER
|
Facility
|
OP
|
$6,431.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
72000029
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$836.03 |
| Max. Negotiated Rate |
$6,173.76 |
| Rate for Payer: Aetna Commercial |
$4,951.87
|
| Rate for Payer: Anthem Medicaid |
$2,211.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,016.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,215.50
|
| Rate for Payer: Cash Price |
$3,215.50
|
| Rate for Payer: Cigna Commercial |
$5,337.73
|
| Rate for Payer: First Health Commercial |
$6,109.45
|
| Rate for Payer: Humana Commercial |
$5,466.35
|
| Rate for Payer: Humana KY Medicaid |
$2,211.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,234.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,273.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,746.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,255.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,659.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,823.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,286.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,993.61
|
| Rate for Payer: PHCS Commercial |
$6,173.76
|
| Rate for Payer: United Healthcare All Payer |
$5,659.28
|
|
|
TX MISSED ABORT 2ND TRIMESTER
|
Professional
|
Both
|
$6,431.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
72000029
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$194.66 |
| Max. Negotiated Rate |
$6,431.00 |
| Rate for Payer: Aetna Commercial |
$564.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$194.66
|
| Rate for Payer: Anthem Medicaid |
$213.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,431.00
|
| Rate for Payer: Cash Price |
$3,215.50
|
| Rate for Payer: Cash Price |
$3,215.50
|
| Rate for Payer: Cigna Commercial |
$521.41
|
| Rate for Payer: Healthspan PPO |
$438.90
|
| Rate for Payer: Humana Medicaid |
$213.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.28
|
| Rate for Payer: Molina Healthcare Passport |
$213.02
|
| Rate for Payer: Multiplan PHCS |
$3,858.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,501.70
|
| Rate for Payer: UHCCP Medicaid |
$204.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.15
|
|
|
TX MISSED ABORT 2ND TRIMESTER
|
Facility
|
IP
|
$6,431.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
72000029
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$836.03 |
| Max. Negotiated Rate |
$6,173.76 |
| Rate for Payer: Aetna Commercial |
$4,951.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,016.18
|
| Rate for Payer: Cash Price |
$3,215.50
|
| Rate for Payer: Cigna Commercial |
$5,337.73
|
| Rate for Payer: First Health Commercial |
$6,109.45
|
| Rate for Payer: Humana Commercial |
$5,466.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,273.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,746.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,929.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,659.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,823.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,286.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,993.61
|
| Rate for Payer: PHCS Commercial |
$6,173.76
|
| Rate for Payer: United Healthcare All Payer |
$5,659.28
|
|
|
TX MISSED ABORT 2ND TRIMESTE(T
|
Facility
|
OP
|
$5,381.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
720T0029
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$699.53 |
| Max. Negotiated Rate |
$5,165.76 |
| Rate for Payer: Aetna Commercial |
$4,143.37
|
| Rate for Payer: Anthem Medicaid |
$1,850.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,197.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,690.50
|
| Rate for Payer: Cash Price |
$2,690.50
|
| Rate for Payer: Cigna Commercial |
$4,466.23
|
| Rate for Payer: First Health Commercial |
$5,111.95
|
| Rate for Payer: Humana Commercial |
$4,573.85
|
| Rate for Payer: Humana KY Medicaid |
$1,850.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,869.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,412.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,971.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,887.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,735.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,035.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.11
|
| Rate for Payer: PHCS Commercial |
$5,165.76
|
| Rate for Payer: United Healthcare All Payer |
$4,735.28
|
|
|
TX MISSED ABORT 2ND TRIMESTE(T
|
Facility
|
IP
|
$5,381.00
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
720T0029
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$699.53 |
| Max. Negotiated Rate |
$5,165.76 |
| Rate for Payer: Aetna Commercial |
$4,143.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,197.18
|
| Rate for Payer: Cash Price |
$2,690.50
|
| Rate for Payer: Cigna Commercial |
$4,466.23
|
| Rate for Payer: First Health Commercial |
$5,111.95
|
| Rate for Payer: Humana Commercial |
$4,573.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,412.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,971.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,614.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,735.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,035.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.11
|
| Rate for Payer: PHCS Commercial |
$5,165.76
|
| Rate for Payer: United Healthcare All Payer |
$4,735.28
|
|
|
TX OF CLSD ELBOW DISLOCATION
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
45000124
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
TX OF CLSD ELBOW DISLOCATION
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
45000124
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
26000023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
26000023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Anthem Medicaid |
$18.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$32.03
|
| Rate for Payer: Healthspan PPO |
$34.16
|
| Rate for Payer: Humana Medicaid |
$18.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.37
|
| Rate for Payer: Molina Healthcare Passport |
$18.99
|
| Rate for Payer: Multiplan PHCS |
$130.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.60
|
| Rate for Payer: UHCCP Medicaid |
$76.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.18
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
26000023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
TX/PRO/DX INJ SAME DRUG ADON
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
26000024
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$63.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$63.28
|
| Rate for Payer: Kentucky WC Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
TX/PRO/DX INJ SAME DRUG ADON
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
26000024
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
TX TIBSHFT FX IMD IMP &/CERCLA
|
Facility
|
OP
|
$2,006.00
|
|
|
Service Code
|
HCPCS 27759
|
| Hospital Charge Code |
76100927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,544.62
|
| Rate for Payer: Anthem Medicaid |
$689.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,564.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cigna Commercial |
$1,664.98
|
| Rate for Payer: First Health Commercial |
$1,905.70
|
| Rate for Payer: Humana Commercial |
$1,705.10
|
| Rate for Payer: Humana KY Medicaid |
$689.86
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$696.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,644.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,480.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$703.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,765.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,504.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.86
|
| Rate for Payer: PHCS Commercial |
$1,925.76
|
| Rate for Payer: United Healthcare All Payer |
$1,765.28
|
|
|
TX TIBSHFT FX IMD IMP &/CERCLA
|
Facility
|
IP
|
$2,006.00
|
|
|
Service Code
|
HCPCS 27759
|
| Hospital Charge Code |
76100927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$1,925.76 |
| Rate for Payer: Aetna Commercial |
$1,544.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,564.68
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cigna Commercial |
$1,664.98
|
| Rate for Payer: First Health Commercial |
$1,905.70
|
| Rate for Payer: Humana Commercial |
$1,705.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,644.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,480.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$601.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,765.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,504.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.86
|
| Rate for Payer: PHCS Commercial |
$1,925.76
|
| Rate for Payer: United Healthcare All Payer |
$1,765.28
|
|
|
TX TIBSHFT FX IMD IMP &/CERCLA
|
Professional
|
Both
|
$2,006.00
|
|
|
Service Code
|
HCPCS 27759
|
| Hospital Charge Code |
76100927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$702.10 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Aetna Commercial |
$1,496.64
|
| Rate for Payer: Anthem Medicaid |
$792.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,006.00
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cigna Commercial |
$1,630.43
|
| Rate for Payer: Healthspan PPO |
$1,355.63
|
| Rate for Payer: Humana Medicaid |
$792.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,250.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$808.05
|
| Rate for Payer: Molina Healthcare Passport |
$792.21
|
| Rate for Payer: Multiplan PHCS |
$1,203.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,404.20
|
| Rate for Payer: UHCCP Medicaid |
$702.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$800.13
|
|
