|
RENAL SHEATH
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem Medicaid |
$386.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Humana KY Medicaid |
$386.89
|
| Rate for Payer: Kentucky WC Medicaid |
$390.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
RENAL SHEATH
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
RENAL SHEATH SET AMPLATZ
|
Facility
|
OP
|
$1,524.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.47 |
| Max. Negotiated Rate |
$1,463.90 |
| Rate for Payer: Aetna Commercial |
$1,174.17
|
| Rate for Payer: Anthem Medicaid |
$524.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.42
|
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Cigna Commercial |
$1,265.67
|
| Rate for Payer: First Health Commercial |
$1,448.65
|
| Rate for Payer: Humana Commercial |
$1,296.16
|
| Rate for Payer: Humana KY Medicaid |
$524.41
|
| Rate for Payer: Kentucky WC Medicaid |
$529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,341.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,219.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.18
|
| Rate for Payer: PHCS Commercial |
$1,463.90
|
| Rate for Payer: United Healthcare All Payer |
$1,341.91
|
|
|
RENAL SHEATH SET AMPLATZ
|
Facility
|
IP
|
$1,524.90
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.47 |
| Max. Negotiated Rate |
$1,463.90 |
| Rate for Payer: Aetna Commercial |
$1,174.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.42
|
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Cigna Commercial |
$1,265.67
|
| Rate for Payer: First Health Commercial |
$1,448.65
|
| Rate for Payer: Humana Commercial |
$1,296.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,341.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,219.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.18
|
| Rate for Payer: PHCS Commercial |
$1,463.90
|
| Rate for Payer: United Healthcare All Payer |
$1,341.91
|
|
|
RENAL VENOGRAPHY BILATERAL
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
32000170
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,340.10 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENAL VENOGRAPHY BILATERAL
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75833
|
| Hospital Charge Code |
32000170
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,536.20 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENAL VENOGRAPHY UNILATERAL
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75831
|
| Hospital Charge Code |
32000169
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,340.10 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENAL VENOGRAPHY UNILATERAL
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75831
|
| Hospital Charge Code |
32000169
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,536.20 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
RENEGADE CATH 180CM
|
Facility
|
OP
|
$3,576.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,073.05 |
| Max. Negotiated Rate |
$3,433.77 |
| Rate for Payer: Aetna Commercial |
$2,754.17
|
| Rate for Payer: Anthem Medicaid |
$1,230.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,789.94
|
| Rate for Payer: Cash Price |
$1,788.42
|
| Rate for Payer: Cigna Commercial |
$2,968.78
|
| Rate for Payer: First Health Commercial |
$3,398.00
|
| Rate for Payer: Humana Commercial |
$3,040.31
|
| Rate for Payer: Humana KY Medicaid |
$1,230.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,242.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,147.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,682.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,861.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,111.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.02
|
| Rate for Payer: PHCS Commercial |
$3,433.77
|
| Rate for Payer: United Healthcare All Payer |
$3,147.62
|
|
|
RENEGADE CATH 180CM
|
Facility
|
IP
|
$3,576.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,073.05 |
| Max. Negotiated Rate |
$3,433.77 |
| Rate for Payer: Aetna Commercial |
$2,754.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,789.94
|
| Rate for Payer: Cash Price |
$1,788.42
|
| Rate for Payer: Cigna Commercial |
$2,968.78
|
| Rate for Payer: First Health Commercial |
$3,398.00
|
| Rate for Payer: Humana Commercial |
$3,040.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,147.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,682.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,861.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,111.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.02
|
| Rate for Payer: PHCS Commercial |
$3,433.77
|
| Rate for Payer: United Healthcare All Payer |
$3,147.62
|
|
|
RENEGADE STC CATH
|
Facility
|
OP
|
$3,668.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,100.62 |
| Max. Negotiated Rate |
$3,522.00 |
| Rate for Payer: Aetna Commercial |
$2,824.94
|
| Rate for Payer: Anthem Medicaid |
$1,261.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,861.62
|
| Rate for Payer: Cash Price |
$1,834.38
|
| Rate for Payer: Cigna Commercial |
$3,045.06
|
| Rate for Payer: First Health Commercial |
$3,485.31
|
| Rate for Payer: Humana Commercial |
$3,118.44
|
| Rate for Payer: Humana KY Medicaid |
$1,261.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,008.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,707.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,228.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,751.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,935.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,191.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.44
|
| Rate for Payer: PHCS Commercial |
$3,522.00
|
| Rate for Payer: United Healthcare All Payer |
$3,228.50
|
|
|
RENEGADE STC CATH
|
Facility
|
IP
|
$3,668.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,100.62 |
| Max. Negotiated Rate |
$3,522.00 |
| Rate for Payer: Aetna Commercial |
$2,824.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,861.62
|
| Rate for Payer: Cash Price |
$1,834.38
|
| Rate for Payer: Cigna Commercial |
$3,045.06
|
| Rate for Payer: First Health Commercial |
$3,485.31
|
| Rate for Payer: Humana Commercial |
$3,118.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,008.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,707.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,228.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,751.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,935.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,191.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.44
|
| Rate for Payer: PHCS Commercial |
$3,522.00
|
| Rate for Payer: United Healthcare All Payer |
$3,228.50
|
|
|
RENFLEXIS 100MG VIAL
|
Facility
|
IP
|
$1,695.39
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
25002727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$508.62 |
| Max. Negotiated Rate |
$1,627.57 |
| Rate for Payer: Aetna Commercial |
$1,305.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,322.40
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cigna Commercial |
$1,407.17
|
| Rate for Payer: First Health Commercial |
$1,610.62
|
| Rate for Payer: Humana Commercial |
$1,441.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,390.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,251.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,271.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,356.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.82
|
| Rate for Payer: PHCS Commercial |
$1,627.57
|
| Rate for Payer: United Healthcare All Payer |
$1,491.94
|
|
|
RENFLEXIS 100MG VIAL
|
Facility
|
OP
|
$1,695.39
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
25002727
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$1,627.57 |
| Rate for Payer: Aetna Commercial |
$1,305.45
|
| Rate for Payer: Anthem Medicaid |
$583.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,322.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.82
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cigna Commercial |
$1,407.17
|
| Rate for Payer: First Health Commercial |
$1,610.62
|
| Rate for Payer: Humana Commercial |
$1,441.08
|
| Rate for Payer: Humana KY Medicaid |
$583.04
|
| Rate for Payer: Humana Medicare Advantage |
$25.05
|
| Rate for Payer: Kentucky WC Medicaid |
$588.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,390.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,251.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,271.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,356.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.82
|
| Rate for Payer: PHCS Commercial |
$1,627.57
|
| Rate for Payer: United Healthcare All Payer |
$1,491.94
|
|
|
REN TIB INS PS STD 1-2*11 R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 1-2*11 R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 1-2*13 R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 1-2*13 R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 1-2*15 R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 1-2*15 R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 3-4*10R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 3-4*10R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 3-4*11R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 3-4*11R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
REN TIB INS PS STD 3-4*13R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
