|
ROTAVIRUS DETECTION
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
30001358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
ROTAVIRUS DETECTION
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
30001358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.42
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
ROTAWIRE FLOPPY
|
Facility
|
OP
|
$1,898.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.84 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna Commercial |
$1,462.08
|
| Rate for Payer: Anthem Medicaid |
$653.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.06
|
| Rate for Payer: Cash Price |
$949.40
|
| Rate for Payer: Cigna Commercial |
$1,576.00
|
| Rate for Payer: First Health Commercial |
$1,803.86
|
| Rate for Payer: Humana Commercial |
$1,613.98
|
| Rate for Payer: Humana KY Medicaid |
$653.00
|
| Rate for Payer: Kentucky WC Medicaid |
$659.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,670.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.63
|
| Rate for Payer: PHCS Commercial |
$1,822.85
|
| Rate for Payer: United Healthcare All Payer |
$1,670.94
|
|
|
ROTAWIRE FLOPPY
|
Facility
|
IP
|
$1,898.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.84 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna Commercial |
$1,462.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.06
|
| Rate for Payer: Cash Price |
$949.40
|
| Rate for Payer: Cigna Commercial |
$1,576.00
|
| Rate for Payer: First Health Commercial |
$1,803.86
|
| Rate for Payer: Humana Commercial |
$1,613.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,670.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.63
|
| Rate for Payer: PHCS Commercial |
$1,822.85
|
| Rate for Payer: United Healthcare All Payer |
$1,670.94
|
|
|
ROTAWIRE X-SUPPORT
|
Facility
|
IP
|
$1,898.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.84 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna Commercial |
$1,462.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.06
|
| Rate for Payer: Cash Price |
$949.40
|
| Rate for Payer: Cigna Commercial |
$1,576.00
|
| Rate for Payer: First Health Commercial |
$1,803.86
|
| Rate for Payer: Humana Commercial |
$1,613.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,670.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.63
|
| Rate for Payer: PHCS Commercial |
$1,822.85
|
| Rate for Payer: United Healthcare All Payer |
$1,670.94
|
|
|
ROTAWIRE X-SUPPORT
|
Facility
|
OP
|
$1,898.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.84 |
| Max. Negotiated Rate |
$1,822.85 |
| Rate for Payer: Aetna Commercial |
$1,462.08
|
| Rate for Payer: Anthem Medicaid |
$653.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,481.06
|
| Rate for Payer: Cash Price |
$949.40
|
| Rate for Payer: Cigna Commercial |
$1,576.00
|
| Rate for Payer: First Health Commercial |
$1,803.86
|
| Rate for Payer: Humana Commercial |
$1,613.98
|
| Rate for Payer: Humana KY Medicaid |
$653.00
|
| Rate for Payer: Kentucky WC Medicaid |
$659.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,557.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,401.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,670.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,424.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.63
|
| Rate for Payer: PHCS Commercial |
$1,822.85
|
| Rate for Payer: United Healthcare All Payer |
$1,670.94
|
|
|
ROUGH PIGWEED IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ROUGH PIGWEED IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ROWASA (MESALAMINE) ENEMA 60ML
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
NDC 62559042011
|
| Hospital Charge Code |
25001347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.69
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna Commercial |
$25.21
|
| Rate for Payer: First Health Commercial |
$28.85
|
| Rate for Payer: Humana Commercial |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.73
|
| Rate for Payer: Ohio Health Group HMO |
$22.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.41
|
| Rate for Payer: PHCS Commercial |
$29.16
|
| Rate for Payer: United Healthcare All Payer |
$26.73
|
|
|
ROWASA (MESALAMINE) ENEMA 60ML
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
NDC 62559042011
|
| Hospital Charge Code |
25001347
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Anthem Medicaid |
$10.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.69
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cigna Commercial |
$25.21
|
| Rate for Payer: First Health Commercial |
$28.85
|
| Rate for Payer: Humana Commercial |
$25.81
|
| Rate for Payer: Humana KY Medicaid |
$10.44
|
| Rate for Payer: Kentucky WC Medicaid |
$10.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.73
|
| Rate for Payer: Ohio Health Group HMO |
$22.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.41
|
| Rate for Payer: PHCS Commercial |
$29.16
|
| Rate for Payer: United Healthcare All Payer |
$26.73
|
|
|
ROZATROL 50 ML GBL
|
Professional
|
Both
|
$88.00
|
|
| Hospital Charge Code |
22200149
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$88.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Multiplan PHCS |
$52.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.60
|
| Rate for Payer: UHCCP Medicaid |
$30.80
|
|
|
RP LOCLZJ TUM SPECT 2 AREAS
|
Facility
|
IP
|
$2,294.00
|
|
|
Service Code
|
HCPCS 78831
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$298.22 |
| Max. Negotiated Rate |
$2,202.24 |
| Rate for Payer: Aetna Commercial |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,789.32
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cigna Commercial |
$1,904.02
|
| Rate for Payer: First Health Commercial |
$2,179.30
|
| Rate for Payer: Humana Commercial |
$1,949.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,881.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,692.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,018.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,720.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.14
|
| Rate for Payer: PHCS Commercial |
$2,202.24
|
| Rate for Payer: United Healthcare All Payer |
$2,018.72
|
|
|
RP LOCLZJ TUM SPECT 2 AREAS
|
Facility
|
OP
|
$2,294.00
|
|
|
Service Code
|
HCPCS 78831
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$298.22 |
| Max. Negotiated Rate |
$2,202.24 |
| Rate for Payer: Aetna Commercial |
$1,766.38
|
| Rate for Payer: Anthem Medicaid |
$788.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,789.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cigna Commercial |
$1,904.02
|
| Rate for Payer: First Health Commercial |
$2,179.30
|
| Rate for Payer: Humana Commercial |
$1,949.90
|
| Rate for Payer: Humana KY Medicaid |
$788.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$796.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,881.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,692.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$804.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,018.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,720.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.14
|
| Rate for Payer: PHCS Commercial |
$2,202.24
|
| Rate for Payer: United Healthcare All Payer |
$2,018.72
|
|
|
RP LOCLZJ TUM SPECT W/CT 1
|
Facility
|
IP
|
$2,294.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
404T0011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$298.22 |
| Max. Negotiated Rate |
$2,202.24 |
| Rate for Payer: Aetna Commercial |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,789.32
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cigna Commercial |
$1,904.02
|
| Rate for Payer: First Health Commercial |
$2,179.30
|
| Rate for Payer: Humana Commercial |
$1,949.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,881.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,692.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,018.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,720.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.14
|
| Rate for Payer: PHCS Commercial |
$2,202.24
|
| Rate for Payer: United Healthcare All Payer |
$2,018.72
|
|
|
RP LOCLZJ TUM SPECT W/CT 1
|
Facility
|
OP
|
$2,294.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
404T0011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$298.22 |
| Max. Negotiated Rate |
$2,202.24 |
| Rate for Payer: Aetna Commercial |
$1,766.38
|
| Rate for Payer: Anthem Medicaid |
$788.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,789.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cigna Commercial |
$1,904.02
|
| Rate for Payer: First Health Commercial |
$2,179.30
|
| Rate for Payer: Humana Commercial |
$1,949.90
|
| Rate for Payer: Humana KY Medicaid |
$788.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$796.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,881.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,692.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$804.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,018.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,720.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$458.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.14
|
| Rate for Payer: PHCS Commercial |
$2,202.24
|
| Rate for Payer: United Healthcare All Payer |
$2,018.72
|
|
|
RP LOCLZJ TUM SPECT W/CT 1
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
404P0011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$377.11 |
| Rate for Payer: Anthem Medicaid |
$369.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Humana Medicaid |
$369.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.11
|
| Rate for Payer: Molina Healthcare Passport |
$369.72
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.42
|
|
|
RPR AA HRN 1ST > 10 RDC
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 49595
|
| Hospital Charge Code |
76102830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.45
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
RPR AA HRN 1ST > 10 RDC
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 49595
|
| Hospital Charge Code |
76102830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.45
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
RPR AA HRN 1ST > 10 RDC
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 49595
|
| Hospital Charge Code |
76102830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Anthem Medicaid |
$647.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$795.00
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Humana Medicaid |
$647.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.14
|
| Rate for Payer: Molina Healthcare Passport |
$647.20
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$556.50
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$653.67
|
|
|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
76102826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
76102826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
76102826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Anthem Medicaid |
$626.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Humana Medicaid |
$626.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$639.27
|
| Rate for Payer: Molina Healthcare Passport |
$626.74
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$633.01
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
76102827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Anthem Medicaid |
$481.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Humana Medicaid |
$481.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$490.72
|
| Rate for Payer: Molina Healthcare Passport |
$481.10
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$203.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$485.91
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
76102827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$556.80 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.80
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
76102827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem Medicaid |
$199.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Humana KY Medicaid |
$199.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$201.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.80
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
