|
RPR EXT TNDN DIS INSERT WO GRF
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 26433
|
| Hospital Charge Code |
76100698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.12 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna Commercial |
$741.80
|
| Rate for Payer: Anthem Medicaid |
$251.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,130.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$935.86
|
| Rate for Payer: Healthspan PPO |
$671.92
|
| Rate for Payer: Humana Medicaid |
$251.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$638.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.14
|
| Rate for Payer: Molina Healthcare Passport |
$251.12
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.00
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.63
|
|
|
RPR EXT TNDN DIS INSERT WO GRF
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 26433
|
| Hospital Charge Code |
76100698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.30
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
RPR EXT TNDN DIS INSERT WO GRF
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 26433
|
| Hospital Charge Code |
761P0698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.12 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Aetna Commercial |
$741.80
|
| Rate for Payer: Anthem Medicaid |
$251.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,130.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$935.86
|
| Rate for Payer: Healthspan PPO |
$671.92
|
| Rate for Payer: Humana Medicaid |
$251.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$638.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$256.14
|
| Rate for Payer: Molina Healthcare Passport |
$251.12
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.00
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.63
|
|
|
RPR EXT TNDN DIS INSERT WO GRF
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 26433
|
| Hospital Charge Code |
76100698
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| 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 |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.30
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
45000051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
45000051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$928.00 |
| Rate for Payer: Aetna Commercial |
$327.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$98.41
|
| Rate for Payer: Anthem Medicaid |
$179.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$928.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cigna Commercial |
$311.04
|
| Rate for Payer: Healthspan PPO |
$342.45
|
| Rate for Payer: Humana Medicaid |
$179.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$190.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.67
|
| Rate for Payer: Molina Healthcare Passport |
$179.09
|
| Rate for Payer: Multiplan PHCS |
$556.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$649.60
|
| Rate for Payer: UHCCP Medicaid |
$103.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.88
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$890.88 |
| Rate for Payer: Aetna Commercial |
$714.56
|
| Rate for Payer: Anthem Medicaid |
$319.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cigna Commercial |
$770.24
|
| Rate for Payer: First Health Commercial |
$881.60
|
| Rate for Payer: Humana Commercial |
$788.80
|
| Rate for Payer: Humana KY Medicaid |
$319.14
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$322.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$816.64
|
| Rate for Payer: Ohio Health Group HMO |
$696.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.68
|
| Rate for Payer: PHCS Commercial |
$890.88
|
| Rate for Payer: United Healthcare All Payer |
$816.64
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$890.88 |
| Rate for Payer: Aetna Commercial |
$714.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.84
|
| Rate for Payer: Cash Price |
$464.00
|
| Rate for Payer: Cigna Commercial |
$770.24
|
| Rate for Payer: First Health Commercial |
$881.60
|
| Rate for Payer: Humana Commercial |
$788.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$816.64
|
| Rate for Payer: Ohio Health Group HMO |
$696.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.68
|
| Rate for Payer: PHCS Commercial |
$890.88
|
| Rate for Payer: United Healthcare All Payer |
$816.64
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 C(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
761P0130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$327.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$98.41
|
| Rate for Payer: Anthem Medicaid |
$179.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$311.04
|
| Rate for Payer: Healthspan PPO |
$342.45
|
| Rate for Payer: Humana Medicaid |
$179.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$190.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.67
|
| Rate for Payer: Molina Healthcare Passport |
$179.09
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$103.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.88
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 C(T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
761T0130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 C(T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12016
|
| Hospital Charge Code |
761T0130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
76100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$1,739.52 |
| Rate for Payer: Aetna Commercial |
$1,395.24
|
| Rate for Payer: Anthem Medicaid |
$623.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$1,503.96
|
| Rate for Payer: First Health Commercial |
$1,721.40
|
| Rate for Payer: Humana Commercial |
$1,540.20
|
| Rate for Payer: Humana KY Medicaid |
$623.15
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$629.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.72
|
| Rate for Payer: PHCS Commercial |
$1,739.52
|
| Rate for Payer: United Healthcare All Payer |
$1,594.56
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
45000052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
45000052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Professional
|
Both
|
$1,812.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
76100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.63 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna Commercial |
$390.50
|
| Rate for Payer: Anthem Medicaid |
$234.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,812.00
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$376.26
|
| Rate for Payer: Healthspan PPO |
$312.24
|
| Rate for Payer: Humana Medicaid |
$234.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.09
|
| Rate for Payer: Molina Healthcare Passport |
$234.40
|
| Rate for Payer: Multiplan PHCS |
$1,087.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,268.40
|
| Rate for Payer: UHCCP Medicaid |
$634.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$236.74
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
76100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$1,739.52 |
| Rate for Payer: Aetna Commercial |
$1,395.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.36
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$1,503.96
|
| Rate for Payer: First Health Commercial |
$1,721.40
|
| Rate for Payer: Humana Commercial |
$1,540.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.72
|
| Rate for Payer: PHCS Commercial |
$1,739.52
|
| Rate for Payer: United Healthcare All Payer |
$1,594.56
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 C(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
761P0131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.63 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$390.50
|
| Rate for Payer: Anthem Medicaid |
$234.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$376.26
|
| Rate for Payer: Healthspan PPO |
$312.24
|
| Rate for Payer: Humana Medicaid |
$234.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.09
|
| Rate for Payer: Molina Healthcare Passport |
$234.40
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$236.74
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 C(T
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
761T0131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.06 |
| Max. Negotiated Rate |
$923.52 |
| Rate for Payer: Aetna Commercial |
$740.74
|
| Rate for Payer: Anthem Medicaid |
$330.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$798.46
|
| Rate for Payer: First Health Commercial |
$913.90
|
| Rate for Payer: Humana Commercial |
$817.70
|
| Rate for Payer: Humana KY Medicaid |
$330.83
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$334.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$337.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$846.56
|
| Rate for Payer: Ohio Health Group HMO |
$721.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.22
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 C(T
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
761T0131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.06 |
| Max. Negotiated Rate |
$923.52 |
| Rate for Payer: Aetna Commercial |
$740.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$750.36
|
| Rate for Payer: Cash Price |
$481.00
|
| Rate for Payer: Cigna Commercial |
$798.46
|
| Rate for Payer: First Health Commercial |
$913.90
|
| Rate for Payer: Humana Commercial |
$817.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$846.56
|
| Rate for Payer: Ohio Health Group HMO |
$721.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.22
|
| Rate for Payer: PHCS Commercial |
$923.52
|
| Rate for Payer: United Healthcare All Payer |
$846.56
|
|
|
RPR F/E/E/N/L/M 2.5 CM/<
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.70
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
RPR F/E/E/N/L/M 2.5 CM/<
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem Medicaid |
$161.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Humana KY Medicaid |
$161.63
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$163.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.70
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
RPR F/E/E/N/L/M 2.5 CM/<
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
45000047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem Medicaid |
$92.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Humana KY Medicaid |
$92.85
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$93.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.70
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
RPR F/E/E/N/L/M 2.5 CM/<
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$154.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$71.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$470.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$146.54
|
| Rate for Payer: Healthspan PPO |
$173.88
|
| Rate for Payer: Humana Medicaid |
$71.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.91
|
| Rate for Payer: Molina Healthcare Passport |
$71.48
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.00
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.19
|
|
|
RPR F/E/E/N/L/M 2.5 CM/<
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.70
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
