|
RPR AA HRN 1ST < 3 CM RDC
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
76102825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.25 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Anthem Medicaid |
$286.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$355.00
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Humana Medicaid |
$286.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.26
|
| Rate for Payer: Molina Healthcare Passport |
$286.53
|
| Rate for Payer: Multiplan PHCS |
$213.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.50
|
| Rate for Payer: UHCCP Medicaid |
$124.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.40
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
76102825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| 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 |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
76102825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
76102834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Anthem Medicaid |
$399.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Humana Medicaid |
$399.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.22
|
| Rate for Payer: Molina Healthcare Passport |
$399.24
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.23
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 49596
|
| Hospital Charge Code |
76102835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Anthem Medicaid |
$859.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,545.00
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Humana Medicaid |
$859.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$877.17
|
| Rate for Payer: Molina Healthcare Passport |
$859.97
|
| Rate for Payer: Multiplan PHCS |
$927.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,081.50
|
| Rate for Payer: UHCCP Medicaid |
$540.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$868.57
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
OP
|
$1,545.00
|
|
|
Service Code
|
HCPCS 49596
|
| Hospital Charge Code |
76102835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.85 |
| Max. Negotiated Rate |
$1,483.20 |
| Rate for Payer: Aetna Commercial |
$1,189.65
|
| Rate for Payer: Anthem Medicaid |
$531.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.10
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$1,282.35
|
| Rate for Payer: First Health Commercial |
$1,467.75
|
| Rate for Payer: Humana Commercial |
$1,313.25
|
| Rate for Payer: Humana KY Medicaid |
$531.33
|
| Rate for Payer: Kentucky WC Medicaid |
$536.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,359.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.95
|
| Rate for Payer: PHCS Commercial |
$1,483.20
|
| Rate for Payer: United Healthcare All Payer |
$1,359.60
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
76102834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| 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 |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
76102834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
IP
|
$1,545.00
|
|
|
Service Code
|
HCPCS 49596
|
| Hospital Charge Code |
76102835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.85 |
| Max. Negotiated Rate |
$1,483.20 |
| Rate for Payer: Aetna Commercial |
$1,189.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.10
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$1,282.35
|
| Rate for Payer: First Health Commercial |
$1,467.75
|
| Rate for Payer: Humana Commercial |
$1,313.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,359.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.95
|
| Rate for Payer: PHCS Commercial |
$1,483.20
|
| Rate for Payer: United Healthcare All Payer |
$1,359.60
|
|
|
RPR AA HRN RCR > 10 NCR/STRN
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
76102841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Anthem Medicaid |
$1,042.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,260.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Humana Medicaid |
$1,042.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,063.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,042.28
|
| Rate for Payer: Multiplan PHCS |
$756.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$882.00
|
| Rate for Payer: UHCCP Medicaid |
$441.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,052.70
|
|
|
RPR AA HRN RCR > 10 NCR/STRN
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
76102841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem Medicaid |
$433.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Humana KY Medicaid |
$433.31
|
| Rate for Payer: Kentucky WC Medicaid |
$437.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.60
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
RPR AA HRN RCR > 10 NCR/STRN
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
76102841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.60
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
RPR AA HRN RCR > 10 RDC
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 49617
|
| Hospital Charge Code |
76102840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.75 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Anthem Medicaid |
$743.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$905.00
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Humana Medicaid |
$743.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$758.23
|
| Rate for Payer: Molina Healthcare Passport |
$743.36
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$633.50
|
| Rate for Payer: UHCCP Medicaid |
$316.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$750.79
|
|
|
RPR AA HRN RCR > 10 RDC
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 49617
|
| Hospital Charge Code |
76102840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem Medicaid |
$311.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Humana KY Medicaid |
$311.23
|
| Rate for Payer: Kentucky WC Medicaid |
$314.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$317.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.55
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
RPR AA HRN RCR > 10 RDC
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 49617
|
| Hospital Charge Code |
76102840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.55
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
RPR AA HRN RCR 3-10 NCR/STRN
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
76102839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Anthem Medicaid |
$721.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Humana Medicaid |
$721.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$736.04
|
| Rate for Payer: Molina Healthcare Passport |
$721.61
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$616.00
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$728.83
|
|
|
RPR AA HRN RCR 3-10 NCR/STRN
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
76102839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.80
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
RPR AA HRN RCR 3-10 NCR/STRN
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
76102839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem Medicaid |
$302.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Humana KY Medicaid |
$302.63
|
| Rate for Payer: Kentucky WC Medicaid |
$305.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.80
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
RPR AA HRN RCR 3-10 RDC
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
76102838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
RPR AA HRN RCR 3-10 RDC
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
76102838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| 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 |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
RPR AA HRN RCR 3-10 RDC
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
76102838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Anthem Medicaid |
$536.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Humana Medicaid |
$536.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$547.63
|
| Rate for Payer: Molina Healthcare Passport |
$536.89
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$542.26
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
76102837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Anthem Medicaid |
$480.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.00
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Humana Medicaid |
$480.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$489.63
|
| Rate for Payer: Molina Healthcare Passport |
$480.03
|
| Rate for Payer: Multiplan PHCS |
$357.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$416.50
|
| Rate for Payer: UHCCP Medicaid |
$208.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$484.83
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
76102837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.45
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
76102837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem Medicaid |
$204.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| 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 |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Humana KY Medicaid |
$204.62
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.45
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
RPR AA HRN RCR < 3 RDC
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
76102836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$342.65
|
| Rate for Payer: Anthem Medicaid |
$153.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.10
|
| 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 |
$222.50
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$369.35
|
| Rate for Payer: First Health Commercial |
$422.75
|
| Rate for Payer: Humana Commercial |
$378.25
|
| Rate for Payer: Humana KY Medicaid |
$153.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$154.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.60
|
| Rate for Payer: Ohio Health Group HMO |
$333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.95
|
| Rate for Payer: PHCS Commercial |
$427.20
|
| Rate for Payer: United Healthcare All Payer |
$391.60
|
|
