|
RPR BLEPH RESCJ/ADVMNT XEXT(P
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
761P2394
|
|
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 CHOANAL ATRESIA INTRANASAL
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
76101133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
761P1133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.74 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$945.48
|
| Rate for Payer: Anthem Medicaid |
$413.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$957.61
|
| Rate for Payer: Healthspan PPO |
$797.34
|
| Rate for Payer: Humana Medicaid |
$413.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.01
|
| Rate for Payer: Molina Healthcare Passport |
$413.74
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$417.88
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
76101133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
76101133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.74 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$945.48
|
| Rate for Payer: Anthem Medicaid |
$413.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$957.61
|
| Rate for Payer: Healthspan PPO |
$797.34
|
| Rate for Payer: Humana Medicaid |
$413.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.01
|
| Rate for Payer: Molina Healthcare Passport |
$413.74
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$417.88
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
76100914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$975.77 |
| Rate for Payer: Aetna Commercial |
$874.93
|
| Rate for Payer: Anthem Medicaid |
$444.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.00
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$975.77
|
| Rate for Payer: Healthspan PPO |
$792.50
|
| Rate for Payer: Humana Medicaid |
$444.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$452.96
|
| Rate for Payer: Molina Healthcare Passport |
$444.08
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$528.50
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.52
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
761P0914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$975.77 |
| Rate for Payer: Aetna Commercial |
$874.93
|
| Rate for Payer: Anthem Medicaid |
$444.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.00
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$975.77
|
| Rate for Payer: Healthspan PPO |
$792.50
|
| Rate for Payer: Humana Medicaid |
$444.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$452.96
|
| Rate for Payer: Molina Healthcare Passport |
$444.08
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$528.50
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.52
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
76100914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
76100914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| 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 |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35151
|
| Hospital Charge Code |
76101367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
IP
|
$2,796.00
|
|
|
Service Code
|
HCPCS 35131
|
| Hospital Charge Code |
76101363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.48 |
| Max. Negotiated Rate |
$2,684.16 |
| Rate for Payer: Aetna Commercial |
$2,152.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,180.88
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$2,320.68
|
| Rate for Payer: First Health Commercial |
$2,656.20
|
| Rate for Payer: Humana Commercial |
$2,376.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,292.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,063.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$838.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,460.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,097.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$559.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$866.76
|
| Rate for Payer: PHCS Commercial |
$2,684.16
|
| Rate for Payer: United Healthcare All Payer |
$2,460.48
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
OP
|
$2,796.00
|
|
|
Service Code
|
HCPCS 35131
|
| Hospital Charge Code |
76101363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.48 |
| Max. Negotiated Rate |
$2,684.16 |
| Rate for Payer: Aetna Commercial |
$2,152.92
|
| Rate for Payer: Anthem Medicaid |
$961.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,180.88
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$2,320.68
|
| Rate for Payer: First Health Commercial |
$2,656.20
|
| Rate for Payer: Humana Commercial |
$2,376.60
|
| Rate for Payer: Humana KY Medicaid |
$961.54
|
| Rate for Payer: Kentucky WC Medicaid |
$971.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,292.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,063.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$838.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$980.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,460.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,097.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$559.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$866.76
|
| Rate for Payer: PHCS Commercial |
$2,684.16
|
| Rate for Payer: United Healthcare All Payer |
$2,460.48
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35151
|
| Hospital Charge Code |
76101367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$945.88 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,216.70
|
| Rate for Payer: Anthem Medicaid |
$945.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,129.02
|
| Rate for Payer: Healthspan PPO |
$2,179.45
|
| Rate for Payer: Humana Medicaid |
$945.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,715.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$964.80
|
| Rate for Payer: Molina Healthcare Passport |
$945.88
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$955.34
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Professional
|
Both
|
$2,796.00
|
|
|
Service Code
|
HCPCS 35131
|
| Hospital Charge Code |
76101363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.60 |
| Max. Negotiated Rate |
$2,796.00 |
| Rate for Payer: Aetna Commercial |
$2,484.65
|
| Rate for Payer: Anthem Medicaid |
$1,001.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,796.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$2,367.96
|
| Rate for Payer: Healthspan PPO |
$2,442.90
|
| Rate for Payer: Humana Medicaid |
$1,001.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,911.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,021.34
|
| Rate for Payer: Molina Healthcare Passport |
$1,001.31
|
| Rate for Payer: Multiplan PHCS |
$1,677.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,957.20
|
| Rate for Payer: UHCCP Medicaid |
$978.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,011.32
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35151
|
| Hospital Charge Code |
76101367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 35103
|
| Hospital Charge Code |
76101362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.95 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem Medicaid |
$864.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Humana KY Medicaid |
$864.91
|
| Rate for Payer: Kentucky WC Medicaid |
$873.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.65
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 35103
|
| Hospital Charge Code |
76101362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.95 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.65
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Professional
|
Both
|
$2,515.00
|
|
|
Service Code
|
HCPCS 35103
|
| Hospital Charge Code |
76101362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.25 |
| Max. Negotiated Rate |
$3,974.93 |
| Rate for Payer: Aetna Commercial |
$3,974.93
|
| Rate for Payer: Anthem Medicaid |
$1,747.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,515.00
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$3,775.11
|
| Rate for Payer: Healthspan PPO |
$3,908.13
|
| Rate for Payer: Humana Medicaid |
$1,747.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,076.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,781.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,747.01
|
| Rate for Payer: Multiplan PHCS |
$1,509.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,760.50
|
| Rate for Payer: UHCCP Medicaid |
$880.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,764.48
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35001
|
| Hospital Charge Code |
76101354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35001
|
| Hospital Charge Code |
76101354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35001
|
| Hospital Charge Code |
76101354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,036.03 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$1,994.67
|
| Rate for Payer: Anthem Medicaid |
$1,036.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$1,911.65
|
| Rate for Payer: Healthspan PPO |
$1,961.15
|
| Rate for Payer: Humana Medicaid |
$1,036.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,541.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,056.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,036.03
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,046.39
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35151
|
| Hospital Charge Code |
761P1367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$945.88 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$2,216.70
|
| Rate for Payer: Anthem Medicaid |
$945.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,129.02
|
| Rate for Payer: Healthspan PPO |
$2,179.45
|
| Rate for Payer: Humana Medicaid |
$945.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,715.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$964.80
|
| Rate for Payer: Molina Healthcare Passport |
$945.88
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$955.34
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35001
|
| Hospital Charge Code |
761P1354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,036.03 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$1,994.67
|
| Rate for Payer: Anthem Medicaid |
$1,036.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$1,911.65
|
| Rate for Payer: Healthspan PPO |
$1,961.15
|
| Rate for Payer: Humana Medicaid |
$1,036.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,541.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,056.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,036.03
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,046.39
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART(P
|
Professional
|
Both
|
$2,515.00
|
|
|
Service Code
|
HCPCS 35103
|
| Hospital Charge Code |
761P1362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$880.25 |
| Max. Negotiated Rate |
$3,974.93 |
| Rate for Payer: Aetna Commercial |
$3,974.93
|
| Rate for Payer: Anthem Medicaid |
$1,747.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,515.00
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$3,775.11
|
| Rate for Payer: Healthspan PPO |
$3,908.13
|
| Rate for Payer: Humana Medicaid |
$1,747.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,076.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,781.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,747.01
|
| Rate for Payer: Multiplan PHCS |
$1,509.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,760.50
|
| Rate for Payer: UHCCP Medicaid |
$880.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,764.48
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART(P
|
Professional
|
Both
|
$2,796.00
|
|
|
Service Code
|
HCPCS 35131
|
| Hospital Charge Code |
761P1363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$978.60 |
| Max. Negotiated Rate |
$2,796.00 |
| Rate for Payer: Aetna Commercial |
$2,484.65
|
| Rate for Payer: Anthem Medicaid |
$1,001.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,796.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$2,367.96
|
| Rate for Payer: Healthspan PPO |
$2,442.90
|
| Rate for Payer: Humana Medicaid |
$1,001.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,911.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,021.34
|
| Rate for Payer: Molina Healthcare Passport |
$1,001.31
|
| Rate for Payer: Multiplan PHCS |
$1,677.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,957.20
|
| Rate for Payer: UHCCP Medicaid |
$978.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,011.32
|
|
