|
INTMD RPR FACE/MM 12.6-20 CM
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.81 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.47
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
INTMD RPR FACE/MM 12.6-20 CM
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.81 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.47
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
INTMD RPR FACE/MM 12.6-20 CM
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.75 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Aetna Commercial |
$402.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$151.75
|
| Rate for Payer: Anthem Medicaid |
$224.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,737.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$378.53
|
| Rate for Payer: Healthspan PPO |
$469.36
|
| Rate for Payer: Humana Medicaid |
$224.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$341.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.91
|
| Rate for Payer: Molina Healthcare Passport |
$224.42
|
| Rate for Payer: Multiplan PHCS |
$1,042.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,215.90
|
| Rate for Payer: UHCCP Medicaid |
$159.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.66
|
|
|
INTMD RPR FACE/MM 12.6-20 CM
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
45000069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
INTMD RPR FACE/MM 12.6-20 CM
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
45000069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
INTMD RPR FACE/MM 12.6-20 C(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
761P0147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.75 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$402.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$151.75
|
| Rate for Payer: Anthem Medicaid |
$224.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$378.53
|
| Rate for Payer: Healthspan PPO |
$469.36
|
| Rate for Payer: Humana Medicaid |
$224.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$341.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.91
|
| Rate for Payer: Molina Healthcare Passport |
$224.42
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$159.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.66
|
|
|
INTMD RPR FACE/MM 12.6-20 C(T
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
761T0147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem Medicaid |
$365.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Humana KY Medicaid |
$365.22
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$372.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
INTMD RPR FACE/MM 12.6-20 C(T
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 12055
|
| Hospital Charge Code |
761T0147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
INTMD RPR FACE/MM >30.0 CM
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
76102580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.80
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
INTMD RPR FACE/MM >30.0 CM
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
76102580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.52 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$559.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$213.52
|
| Rate for Payer: Anthem Medicaid |
$334.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,680.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$705.56
|
| Rate for Payer: Healthspan PPO |
$618.57
|
| Rate for Payer: Humana Medicaid |
$334.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.17
|
| Rate for Payer: Molina Healthcare Passport |
$334.48
|
| Rate for Payer: Multiplan PHCS |
$1,008.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,176.00
|
| Rate for Payer: UHCCP Medicaid |
$224.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.82
|
|
|
INTMD RPR FACE/MM >30.0 CM
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
76102580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.80
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
INTMD RPR FACE/MM >30.0 CM(P
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
761P2580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.52 |
| Max. Negotiated Rate |
$705.56 |
| Rate for Payer: Aetna Commercial |
$559.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$213.52
|
| Rate for Payer: Anthem Medicaid |
$334.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$429.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$705.56
|
| Rate for Payer: Healthspan PPO |
$618.57
|
| Rate for Payer: Humana Medicaid |
$334.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.17
|
| Rate for Payer: Molina Healthcare Passport |
$334.48
|
| Rate for Payer: Multiplan PHCS |
$257.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$300.30
|
| Rate for Payer: UHCCP Medicaid |
$224.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.82
|
|
|
INTMD RPR FACE/MM >30.0 CM(T
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
761T2580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.63 |
| Max. Negotiated Rate |
$1,200.96 |
| Rate for Payer: Aetna Commercial |
$963.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.78
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,038.33
|
| Rate for Payer: First Health Commercial |
$1,188.45
|
| Rate for Payer: Humana Commercial |
$1,063.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$923.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.88
|
| Rate for Payer: Ohio Health Group HMO |
$938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.81
|
| Rate for Payer: PHCS Commercial |
$1,200.96
|
| Rate for Payer: United Healthcare All Payer |
$1,100.88
|
|
|
INTMD RPR FACE/MM >30.0 CM(T
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 12057
|
| Hospital Charge Code |
761T2580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.63 |
| Max. Negotiated Rate |
$1,200.96 |
| Rate for Payer: Aetna Commercial |
$963.27
|
| Rate for Payer: Anthem Medicaid |
$430.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,038.33
|
| Rate for Payer: First Health Commercial |
$1,188.45
|
| Rate for Payer: Humana Commercial |
$1,063.35
|
| Rate for Payer: Humana KY Medicaid |
$430.22
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$923.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.88
|
| Rate for Payer: Ohio Health Group HMO |
$938.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.81
|
| Rate for Payer: PHCS Commercial |
$1,200.96
|
| Rate for Payer: United Healthcare All Payer |
$1,100.88
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$1,362.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.06 |
| Max. Negotiated Rate |
$1,307.52 |
| Rate for Payer: Aetna Commercial |
$1,048.74
|
| Rate for Payer: Anthem Medicaid |
$468.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$1,130.46
|
| Rate for Payer: First Health Commercial |
$1,293.90
|
| Rate for Payer: Humana Commercial |
$1,157.70
|
| Rate for Payer: Humana KY Medicaid |
$468.39
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$473.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,116.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,198.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.22
|
| Rate for Payer: PHCS Commercial |
$1,307.52
|
| Rate for Payer: United Healthcare All Payer |
$1,198.56
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$1,362.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.06 |
| Max. Negotiated Rate |
$1,307.52 |
| Rate for Payer: Aetna Commercial |
$1,048.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.36
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$1,130.46
|
| Rate for Payer: First Health Commercial |
$1,293.90
|
| Rate for Payer: Humana Commercial |
$1,157.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,116.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,198.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.22
|
| Rate for Payer: PHCS Commercial |
$1,307.52
|
| Rate for Payer: United Healthcare All Payer |
$1,198.56
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
45000064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.08 |
| Max. Negotiated Rate |
$1,362.00 |
| Rate for Payer: Aetna Commercial |
$355.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.08
|
| Rate for Payer: Anthem Medicaid |
$168.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,362.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$339.86
|
| Rate for Payer: Healthspan PPO |
$409.65
|
| Rate for Payer: Humana Medicaid |
$168.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.42
|
| Rate for Payer: Molina Healthcare Passport |
$168.06
|
| Rate for Payer: Multiplan PHCS |
$817.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$953.40
|
| Rate for Payer: UHCCP Medicaid |
$144.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.74
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
45000064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
INTMD RPR N-HF/GENIT12.6-20(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
761P0141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.08 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$355.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.08
|
| Rate for Payer: Anthem Medicaid |
$168.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$339.86
|
| Rate for Payer: Healthspan PPO |
$409.65
|
| Rate for Payer: Humana Medicaid |
$168.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$302.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.42
|
| Rate for Payer: Molina Healthcare Passport |
$168.06
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$144.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.74
|
|
|
INTMD RPR N-HF/GENIT12.6-20(T
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
761T0141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
INTMD RPR N-HF/GENIT12.6-20(T
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
761T0141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
INTMD RPR N-HF/GENIT20.1-30
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
76102579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.69 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$420.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.69
|
| Rate for Payer: Anthem Medicaid |
$207.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,633.00
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cigna Commercial |
$402.31
|
| Rate for Payer: Healthspan PPO |
$486.72
|
| Rate for Payer: Humana Medicaid |
$207.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.03
|
| Rate for Payer: Molina Healthcare Passport |
$207.87
|
| Rate for Payer: Multiplan PHCS |
$979.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,143.10
|
| Rate for Payer: UHCCP Medicaid |
$171.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.95
|
|
|
INTMD RPR N-HF/GENIT20.1-30
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
76102579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.29 |
| Max. Negotiated Rate |
$1,567.68 |
| Rate for Payer: Aetna Commercial |
$1,257.41
|
| Rate for Payer: Anthem Medicaid |
$561.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,273.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cigna Commercial |
$1,355.39
|
| Rate for Payer: First Health Commercial |
$1,551.35
|
| Rate for Payer: Humana Commercial |
$1,388.05
|
| Rate for Payer: Humana KY Medicaid |
$561.59
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$567.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,339.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,205.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$572.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,437.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.23
|
| Rate for Payer: PHCS Commercial |
$1,567.68
|
| Rate for Payer: United Healthcare All Payer |
$1,437.04
|
|
|
INTMD RPR N-HF/GENIT20.1-30
|
Facility
|
IP
|
$1,633.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
76102579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.29 |
| Max. Negotiated Rate |
$1,567.68 |
| Rate for Payer: Aetna Commercial |
$1,257.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,273.74
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cigna Commercial |
$1,355.39
|
| Rate for Payer: First Health Commercial |
$1,551.35
|
| Rate for Payer: Humana Commercial |
$1,388.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,339.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,205.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,437.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.23
|
| Rate for Payer: PHCS Commercial |
$1,567.68
|
| Rate for Payer: United Healthcare All Payer |
$1,437.04
|
|
