|
INTMD RPR N-HF/GENIT20.1-30(P
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
761P2579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.69 |
| Max. Negotiated Rate |
$486.72 |
| 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 |
$319.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| 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 |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$171.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.95
|
|
|
INTMD RPR N-HF/GENIT20.1-30(T
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
761T2579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.82 |
| Max. Negotiated Rate |
$1,261.44 |
| Rate for Payer: Aetna Commercial |
$1,011.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.92
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$1,090.62
|
| Rate for Payer: First Health Commercial |
$1,248.30
|
| Rate for Payer: Humana Commercial |
$1,116.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,077.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$969.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,156.32
|
| Rate for Payer: Ohio Health Group HMO |
$985.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.34
|
| Rate for Payer: PHCS Commercial |
$1,261.44
|
| Rate for Payer: United Healthcare All Payer |
$1,156.32
|
|
|
INTMD RPR N-HF/GENIT20.1-30(T
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
761T2579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.82 |
| Max. Negotiated Rate |
$1,261.44 |
| Rate for Payer: Aetna Commercial |
$1,011.78
|
| Rate for Payer: Anthem Medicaid |
$451.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$1,090.62
|
| Rate for Payer: First Health Commercial |
$1,248.30
|
| Rate for Payer: Humana Commercial |
$1,116.90
|
| Rate for Payer: Humana KY Medicaid |
$451.88
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$456.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,077.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$969.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,156.32
|
| Rate for Payer: Ohio Health Group HMO |
$985.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.34
|
| Rate for Payer: PHCS Commercial |
$1,261.44
|
| Rate for Payer: United Healthcare All Payer |
$1,156.32
|
|
|
INTMD RPR N-HF/GENIT >30.0CM
|
Facility
|
IP
|
$5,109.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
76100142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.17 |
| Max. Negotiated Rate |
$4,904.64 |
| Rate for Payer: Aetna Commercial |
$3,933.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,985.02
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cigna Commercial |
$4,240.47
|
| Rate for Payer: First Health Commercial |
$4,853.55
|
| Rate for Payer: Humana Commercial |
$4,342.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,189.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,770.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,532.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,495.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,583.79
|
| Rate for Payer: PHCS Commercial |
$4,904.64
|
| Rate for Payer: United Healthcare All Payer |
$4,495.92
|
|
|
INTMD RPR N-HF/GENIT >30.0CM
|
Professional
|
Both
|
$5,109.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
76100142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$5,109.00 |
| Rate for Payer: Aetna Commercial |
$460.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$181.86
|
| Rate for Payer: Anthem Medicaid |
$256.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,109.00
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cigna Commercial |
$442.93
|
| Rate for Payer: Healthspan PPO |
$522.43
|
| Rate for Payer: Humana Medicaid |
$256.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.54
|
| Rate for Payer: Molina Healthcare Passport |
$256.41
|
| Rate for Payer: Multiplan PHCS |
$3,065.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,576.30
|
| Rate for Payer: UHCCP Medicaid |
$190.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.97
|
|
|
INTMD RPR N-HF/GENIT >30.0CM
|
Facility
|
OP
|
$5,109.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
76100142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.17 |
| Max. Negotiated Rate |
$4,904.64 |
| Rate for Payer: Aetna Commercial |
$3,933.93
|
| Rate for Payer: Anthem Medicaid |
$1,756.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,985.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cash Price |
$2,554.50
|
| Rate for Payer: Cigna Commercial |
$4,240.47
|
| Rate for Payer: First Health Commercial |
$4,853.55
|
| Rate for Payer: Humana Commercial |
$4,342.65
|
| Rate for Payer: Humana KY Medicaid |
$1,756.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,774.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,189.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,770.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,792.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,495.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,583.79
|
| Rate for Payer: PHCS Commercial |
$4,904.64
|
| Rate for Payer: United Healthcare All Payer |
$4,495.92
|
|
|
INTMD RPR N-HF/GENIT >30.0C(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
761P0142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$460.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$181.86
|
| Rate for Payer: Anthem Medicaid |
$256.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$442.93
|
| Rate for Payer: Healthspan PPO |
$522.43
|
| Rate for Payer: Humana Medicaid |
$256.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.54
|
| Rate for Payer: Molina Healthcare Passport |
$256.41
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$190.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.97
|
|
|
INTMD RPR N-HF/GENIT >30.0C(T
|
Facility
|
OP
|
$4,559.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
761T0142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$592.67 |
| Max. Negotiated Rate |
$4,376.64 |
| Rate for Payer: Aetna Commercial |
$3,510.43
|
| Rate for Payer: Anthem Medicaid |
$1,567.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,556.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$3,783.97
|
| Rate for Payer: First Health Commercial |
$4,331.05
|
| Rate for Payer: Humana Commercial |
$3,875.15
|
| Rate for Payer: Humana KY Medicaid |
$1,567.84
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,583.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,738.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,364.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,599.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,011.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.29
|
| Rate for Payer: PHCS Commercial |
$4,376.64
|
| Rate for Payer: United Healthcare All Payer |
$4,011.92
|
|
|
INTMD RPR N-HF/GENIT >30.0C(T
|
Facility
|
IP
|
$4,559.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
761T0142
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$592.67 |
| Max. Negotiated Rate |
$4,376.64 |
| Rate for Payer: Aetna Commercial |
$3,510.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,556.02
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$3,783.97
|
| Rate for Payer: First Health Commercial |
$4,331.05
|
| Rate for Payer: Humana Commercial |
$3,875.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,738.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,364.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,011.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.29
|
| Rate for Payer: PHCS Commercial |
$4,376.64
|
| Rate for Payer: United Healthcare All Payer |
$4,011.92
|
|
|
INTMD RPR N-HF/GENIT7.6-12.5
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
76100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$1,971.00 |
| Rate for Payer: Aetna Commercial |
$303.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.97
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,971.00
|
| Rate for Payer: Cash Price |
$985.50
|
| Rate for Payer: Cash Price |
$985.50
|
| Rate for Payer: Cigna Commercial |
$276.17
|
| Rate for Payer: Healthspan PPO |
$366.66
|
| Rate for Payer: Humana Medicaid |
$138.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.02
|
| Rate for Payer: Molina Healthcare Passport |
$138.25
|
| Rate for Payer: Multiplan PHCS |
$1,182.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,379.70
|
| Rate for Payer: UHCCP Medicaid |
$113.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.63
|
|
|
INTMD RPR N-HF/GENIT7.6-12.5
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
45000063
|
|
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/GENIT7.6-12.5
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
76100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.23 |
| Max. Negotiated Rate |
$1,892.16 |
| Rate for Payer: Aetna Commercial |
$1,517.67
|
| Rate for Payer: Anthem Medicaid |
$677.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,537.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$985.50
|
| Rate for Payer: Cash Price |
$985.50
|
| Rate for Payer: Cigna Commercial |
$1,635.93
|
| Rate for Payer: First Health Commercial |
$1,872.45
|
| Rate for Payer: Humana Commercial |
$1,675.35
|
| Rate for Payer: Humana KY Medicaid |
$677.83
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$684.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,454.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,734.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.01
|
| Rate for Payer: PHCS Commercial |
$1,892.16
|
| Rate for Payer: United Healthcare All Payer |
$1,734.48
|
|
|
INTMD RPR N-HF/GENIT7.6-12.5
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
45000063
|
|
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/GENIT7.6-12.5
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
76100140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.23 |
| Max. Negotiated Rate |
$1,892.16 |
| Rate for Payer: Aetna Commercial |
$1,517.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,537.38
|
| Rate for Payer: Cash Price |
$985.50
|
| Rate for Payer: Cigna Commercial |
$1,635.93
|
| Rate for Payer: First Health Commercial |
$1,872.45
|
| Rate for Payer: Humana Commercial |
$1,675.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,454.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,734.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.01
|
| Rate for Payer: PHCS Commercial |
$1,892.16
|
| Rate for Payer: United Healthcare All Payer |
$1,734.48
|
|
|
INTMD RPR N-HF/GENIT7.6-12.(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
761P0140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: UHCCP Medicaid |
$113.37
|
| Rate for Payer: Aetna Commercial |
$303.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.97
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$276.17
|
| Rate for Payer: Healthspan PPO |
$366.66
|
| Rate for Payer: Humana Medicaid |
$138.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.02
|
| Rate for Payer: Molina Healthcare Passport |
$138.25
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.63
|
|
|
INTMD RPR N-HF/GENIT7.6-12.(T
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
761T0140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$1,028.16 |
| Rate for Payer: Aetna Commercial |
$824.67
|
| Rate for Payer: Anthem Medicaid |
$368.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$888.93
|
| Rate for Payer: First Health Commercial |
$1,017.45
|
| Rate for Payer: Humana Commercial |
$910.35
|
| Rate for Payer: Humana KY Medicaid |
$368.32
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$372.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.48
|
| Rate for Payer: Ohio Health Group HMO |
$803.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.01
|
| Rate for Payer: PHCS Commercial |
$1,028.16
|
| Rate for Payer: United Healthcare All Payer |
$942.48
|
|
|
INTMD RPR N-HF/GENIT7.6-12.(T
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
761T0140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$1,028.16 |
| Rate for Payer: Aetna Commercial |
$824.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.38
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$888.93
|
| Rate for Payer: First Health Commercial |
$1,017.45
|
| Rate for Payer: Humana Commercial |
$910.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.48
|
| Rate for Payer: Ohio Health Group HMO |
$803.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.01
|
| Rate for Payer: PHCS Commercial |
$1,028.16
|
| Rate for Payer: United Healthcare All Payer |
$942.48
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
761T2581
|
|
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 S/A/T/EXT 20.1-30
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
76102581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$1,225.92 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Anthem Medicaid |
$439.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,059.91
|
| Rate for Payer: First Health Commercial |
$1,213.15
|
| Rate for Payer: Humana Commercial |
$1,085.45
|
| Rate for Payer: Humana KY Medicaid |
$439.16
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$443.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$942.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$957.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.87
|
| Rate for Payer: PHCS Commercial |
$1,225.92
|
| Rate for Payer: United Healthcare All Payer |
$1,123.76
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
761P2581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.66 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna Commercial |
$398.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.66
|
| Rate for Payer: Anthem Medicaid |
$188.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$382.89
|
| Rate for Payer: Healthspan PPO |
$448.52
|
| Rate for Payer: Humana Medicaid |
$188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$192.36
|
| Rate for Payer: Molina Healthcare Passport |
$188.59
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$151.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$190.48
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
76102581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$1,225.92 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.06
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$1,059.91
|
| Rate for Payer: First Health Commercial |
$1,213.15
|
| Rate for Payer: Humana Commercial |
$1,085.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$942.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$957.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.87
|
| Rate for Payer: PHCS Commercial |
$1,225.92
|
| Rate for Payer: United Healthcare All Payer |
$1,123.76
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
76102581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.66 |
| Max. Negotiated Rate |
$1,277.00 |
| Rate for Payer: Aetna Commercial |
$398.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.66
|
| Rate for Payer: Anthem Medicaid |
$188.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,277.00
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cash Price |
$638.50
|
| Rate for Payer: Cigna Commercial |
$382.89
|
| Rate for Payer: Healthspan PPO |
$448.52
|
| Rate for Payer: Humana Medicaid |
$188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$192.36
|
| Rate for Payer: Molina Healthcare Passport |
$188.59
|
| Rate for Payer: Multiplan PHCS |
$766.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.90
|
| Rate for Payer: UHCCP Medicaid |
$151.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$190.48
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
761T2581
|
|
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 S/TR/EXT >30.0 CM
|
Facility
|
OP
|
$3,053.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
76102582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.89 |
| Max. Negotiated Rate |
$2,930.88 |
| Rate for Payer: Aetna Commercial |
$2,350.81
|
| Rate for Payer: Anthem Medicaid |
$1,049.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,381.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,526.50
|
| Rate for Payer: Cash Price |
$1,526.50
|
| Rate for Payer: Cigna Commercial |
$2,533.99
|
| Rate for Payer: First Health Commercial |
$2,900.35
|
| Rate for Payer: Humana Commercial |
$2,595.05
|
| Rate for Payer: Humana KY Medicaid |
$1,049.93
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,060.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,503.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,253.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,070.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,686.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,289.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$946.43
|
| Rate for Payer: PHCS Commercial |
$2,930.88
|
| Rate for Payer: United Healthcare All Payer |
$2,686.64
|
|
|
INTMD RPR S/TR/EXT >30.0 CM
|
Facility
|
IP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
761T2582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.99 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.13
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
