|
RPR AA HRN RCR < 3 RDC
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
76102836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$427.20 |
| Rate for Payer: Aetna Commercial |
$342.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.10
|
| 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: 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 |
$133.50
|
| 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
|
|
|
RPR AA HRN RCR < 3 RDC
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
76102836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Anthem Medicaid |
$353.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$445.00
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Humana Medicaid |
$353.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.46
|
| Rate for Payer: Molina Healthcare Passport |
$353.39
|
| Rate for Payer: Multiplan PHCS |
$267.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$311.50
|
| Rate for Payer: UHCCP Medicaid |
$155.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.92
|
|
|
RPR/ADV FLXR TDN WFR GRAFT
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
76100690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,293.08
|
| Rate for Payer: Anthem Medicaid |
$484.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,588.57
|
| Rate for Payer: Healthspan PPO |
$1,171.25
|
| Rate for Payer: Humana Medicaid |
$484.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,122.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.03
|
| Rate for Payer: Molina Healthcare Passport |
$484.34
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,785.00
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.18
|
|
|
RPR/ADV FLXR TDN WFR GRAFT
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
76100690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem Medicaid |
$876.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Humana KY Medicaid |
$876.94
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$885.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$894.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
RPR/ADV FLXR TDN WFR GRAFT
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
76100690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$765.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
RPR/ADV FLXR TDN WFR GRAFT(P
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
761P0690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,293.08
|
| Rate for Payer: Anthem Medicaid |
$484.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,588.57
|
| Rate for Payer: Healthspan PPO |
$1,171.25
|
| Rate for Payer: Humana Medicaid |
$484.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,122.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.03
|
| Rate for Payer: Molina Healthcare Passport |
$484.34
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,785.00
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.18
|
|
|
RPR/ADV FLXR TDN W/O FR GRF(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
761P0688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.39 |
| Max. Negotiated Rate |
$1,775.00 |
| Rate for Payer: Aetna Commercial |
$1,473.06
|
| Rate for Payer: Anthem Medicaid |
$430.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,775.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,764.28
|
| Rate for Payer: Healthspan PPO |
$1,334.28
|
| Rate for Payer: Humana Medicaid |
$430.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,311.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$439.00
|
| Rate for Payer: Molina Healthcare Passport |
$430.39
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.50
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.69
|
|
|
RPR/ADV FLXR TDN W/O FR GRFT
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
76100688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.25
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
RPR/ADV FLXR TDN W/O FR GRFT
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
76100688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.39 |
| Max. Negotiated Rate |
$1,775.00 |
| Rate for Payer: Aetna Commercial |
$1,473.06
|
| Rate for Payer: Anthem Medicaid |
$430.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,775.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,764.28
|
| Rate for Payer: Healthspan PPO |
$1,334.28
|
| Rate for Payer: Humana Medicaid |
$430.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,311.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$439.00
|
| Rate for Payer: Molina Healthcare Passport |
$430.39
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.50
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.69
|
|
|
RPR/ADV FLXR TDN W/O FR GRFT
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
76100688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$616.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.25
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
RPR/ADV FLXR TDN WO FR GRFT
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
76100689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.85 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,223.43
|
| Rate for Payer: Anthem Medicaid |
$444.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,495.23
|
| Rate for Payer: Healthspan PPO |
$1,108.16
|
| Rate for Payer: Humana Medicaid |
$444.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,051.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.75
|
| Rate for Payer: Molina Healthcare Passport |
$444.85
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.30
|
|
|
RPR/ADV FLXR TDN WO FR GRFT
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
76100689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
RPR/ADV FLXR TDN WO FR GRFT
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
76100689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
RPR/ADV FLXR TDN WO FR GRFT(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
761P0689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.85 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,223.43
|
| Rate for Payer: Anthem Medicaid |
$444.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,495.23
|
| Rate for Payer: Healthspan PPO |
$1,108.16
|
| Rate for Payer: Humana Medicaid |
$444.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,051.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.75
|
| Rate for Payer: Molina Healthcare Passport |
$444.85
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.30
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
76100691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem Medicaid |
$576.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Humana KY Medicaid |
$576.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$581.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$587.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.25
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
76100691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.33 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna Commercial |
$1,080.76
|
| Rate for Payer: Anthem Medicaid |
$404.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,675.00
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,356.86
|
| Rate for Payer: Healthspan PPO |
$978.94
|
| Rate for Payer: Humana Medicaid |
$404.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.42
|
| Rate for Payer: Molina Healthcare Passport |
$404.33
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,172.50
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.37
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
76100691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$502.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.25
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
761P0691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.33 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna Commercial |
$1,080.76
|
| Rate for Payer: Anthem Medicaid |
$404.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,675.00
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,356.86
|
| Rate for Payer: Healthspan PPO |
$978.94
|
| Rate for Payer: Humana Medicaid |
$404.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.42
|
| Rate for Payer: Molina Healthcare Passport |
$404.33
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,172.50
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.37
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
76100692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
761P0692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.77 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,192.32
|
| Rate for Payer: Anthem Medicaid |
$435.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,485.53
|
| Rate for Payer: Healthspan PPO |
$1,079.99
|
| Rate for Payer: Humana Medicaid |
$435.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$444.49
|
| Rate for Payer: Molina Healthcare Passport |
$435.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$440.13
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
76100692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.77 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,192.32
|
| Rate for Payer: Anthem Medicaid |
$435.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,485.53
|
| Rate for Payer: Healthspan PPO |
$1,079.99
|
| Rate for Payer: Humana Medicaid |
$435.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$444.49
|
| Rate for Payer: Molina Healthcare Passport |
$435.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$440.13
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
76100692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
76102394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
76102394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$1,735.00 |
| Rate for Payer: Aetna Commercial |
$776.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.96
|
| Rate for Payer: Anthem Medicaid |
$397.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,735.00
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$732.79
|
| Rate for Payer: Healthspan PPO |
$838.96
|
| Rate for Payer: Humana Medicaid |
$397.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$751.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.00
|
| Rate for Payer: Molina Healthcare Passport |
$397.06
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,214.50
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.03
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
76102394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
