|
RPR F/E/E/N/L/M 2.5 CM/<(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
761P0126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$200.00 |
| 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 |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| 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/<(T
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
761T0126
|
|
Hospital Revenue Code
|
761
|
| 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/<(T
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
761T0126
|
|
Hospital Revenue Code
|
761
|
| 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 2.6-5.0 CM
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.49 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem Medicaid |
$197.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Humana KY Medicaid |
$197.05
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$199.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.63
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.49 |
| Max. Negotiated Rate |
$550.08 |
| Rate for Payer: Aetna Commercial |
$441.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.94
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$475.59
|
| Rate for Payer: First Health Commercial |
$544.35
|
| Rate for Payer: Humana Commercial |
$487.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$504.24
|
| Rate for Payer: Ohio Health Group HMO |
$429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.63
|
| Rate for Payer: PHCS Commercial |
$550.08
|
| Rate for Payer: United Healthcare All Payer |
$504.24
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
45000048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.94
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.13
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$41.80
|
| Rate for Payer: Anthem Medicaid |
$86.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$573.00
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$167.79
|
| Rate for Payer: Healthspan PPO |
$192.04
|
| Rate for Payer: Humana Medicaid |
$86.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.23
|
| Rate for Payer: Molina Healthcare Passport |
$86.50
|
| Rate for Payer: Multiplan PHCS |
$343.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$401.10
|
| Rate for Payer: UHCCP Medicaid |
$43.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.36
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
45000048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem Medicaid |
$111.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Humana KY Medicaid |
$111.08
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$112.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.13
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
761P0127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$41.80
|
| Rate for Payer: Anthem Medicaid |
$86.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$167.79
|
| Rate for Payer: Healthspan PPO |
$192.04
|
| Rate for Payer: Humana Medicaid |
$86.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.23
|
| Rate for Payer: Molina Healthcare Passport |
$86.50
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$43.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.36
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM(T
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
761T0127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.94
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.13
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM(T
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
761T0127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.99 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem Medicaid |
$111.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Humana KY Medicaid |
$111.08
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$112.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.13
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
RPR LAC 2.5CM OR LESS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
45000252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
RPR LAC 2.5CM OR LESS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
45000252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$482.37 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
RPR LAC 2.5CM OR LESS
|
Professional
|
Both
|
$1,089.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
76101661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$1,089.16 |
| Rate for Payer: Aetna Commercial |
$202.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.45
|
| Rate for Payer: Anthem Medicaid |
$85.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,089.16
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cigna Commercial |
$188.30
|
| Rate for Payer: Healthspan PPO |
$261.39
|
| Rate for Payer: Humana Medicaid |
$85.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.67
|
| Rate for Payer: Molina Healthcare Passport |
$85.95
|
| Rate for Payer: Multiplan PHCS |
$653.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$762.41
|
| Rate for Payer: UHCCP Medicaid |
$94.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.81
|
|
|
RPR LAC 2.5CM OR LESS
|
Facility
|
IP
|
$1,089.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
76101661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.59 |
| Max. Negotiated Rate |
$1,045.59 |
| Rate for Payer: Aetna Commercial |
$838.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.54
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cigna Commercial |
$904.00
|
| Rate for Payer: First Health Commercial |
$1,034.70
|
| Rate for Payer: Humana Commercial |
$925.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.46
|
| Rate for Payer: Ohio Health Group HMO |
$816.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.64
|
| Rate for Payer: PHCS Commercial |
$1,045.59
|
| Rate for Payer: United Healthcare All Payer |
$958.46
|
|
|
RPR LAC 2.5CM OR LESS
|
Facility
|
OP
|
$1,089.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
76101661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.59 |
| Max. Negotiated Rate |
$1,045.59 |
| Rate for Payer: Aetna Commercial |
$838.65
|
| Rate for Payer: Anthem Medicaid |
$374.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cigna Commercial |
$904.00
|
| Rate for Payer: First Health Commercial |
$1,034.70
|
| Rate for Payer: Humana Commercial |
$925.79
|
| Rate for Payer: Humana KY Medicaid |
$374.56
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$378.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.46
|
| Rate for Payer: Ohio Health Group HMO |
$816.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.64
|
| Rate for Payer: PHCS Commercial |
$1,045.59
|
| Rate for Payer: United Healthcare All Payer |
$958.46
|
|
|
RPR LAC 2.5CM OR LESS(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
761P1661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$202.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.45
|
| Rate for Payer: Anthem Medicaid |
$85.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$188.30
|
| Rate for Payer: Healthspan PPO |
$261.39
|
| Rate for Payer: Humana Medicaid |
$85.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.67
|
| Rate for Payer: Molina Healthcare Passport |
$85.95
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$94.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.81
|
|
|
RPR LAC 2.5CM OR LESS(T
|
Facility
|
OP
|
$514.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
761T1661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.84 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$176.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cigna Commercial |
$426.75
|
| Rate for Payer: First Health Commercial |
$488.45
|
| Rate for Payer: Humana Commercial |
$437.04
|
| Rate for Payer: Humana KY Medicaid |
$176.82
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$178.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.46
|
| Rate for Payer: Ohio Health Group HMO |
$385.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$493.59
|
| Rate for Payer: United Healthcare All Payer |
$452.46
|
|
|
RPR LAC 2.5CM OR LESS(T
|
Facility
|
IP
|
$514.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
761T1661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.84 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.04
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cigna Commercial |
$426.75
|
| Rate for Payer: First Health Commercial |
$488.45
|
| Rate for Payer: Humana Commercial |
$437.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.46
|
| Rate for Payer: Ohio Health Group HMO |
$385.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.39
|
| Rate for Payer: PHCS Commercial |
$493.59
|
| Rate for Payer: United Healthcare All Payer |
$452.46
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
OP
|
$2,120.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
76101663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$2,035.68 |
| Rate for Payer: Aetna Commercial |
$1,632.78
|
| Rate for Payer: Anthem Medicaid |
$729.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: First Health Commercial |
$2,014.48
|
| Rate for Payer: Humana Commercial |
$1,802.42
|
| Rate for Payer: Humana KY Medicaid |
$729.24
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$736.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,866.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.36
|
| Rate for Payer: PHCS Commercial |
$2,035.68
|
| Rate for Payer: United Healthcare All Payer |
$1,866.04
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
45000254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
IP
|
$2,120.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
76101663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.66 |
| Max. Negotiated Rate |
$2,035.68 |
| Rate for Payer: Aetna Commercial |
$1,632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.99
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: First Health Commercial |
$2,014.48
|
| Rate for Payer: Humana Commercial |
$1,802.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,866.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.36
|
| Rate for Payer: PHCS Commercial |
$2,035.68
|
| Rate for Payer: United Healthcare All Payer |
$1,866.04
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Professional
|
Both
|
$2,120.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
76101663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.84 |
| Max. Negotiated Rate |
$2,120.50 |
| Rate for Payer: Aetna Commercial |
$306.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.84
|
| Rate for Payer: Anthem Medicaid |
$155.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,120.50
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cigna Commercial |
$303.19
|
| Rate for Payer: Healthspan PPO |
$357.06
|
| Rate for Payer: Humana Medicaid |
$155.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$273.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.13
|
| Rate for Payer: Molina Healthcare Passport |
$155.03
|
| Rate for Payer: Multiplan PHCS |
$1,272.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,484.35
|
| Rate for Payer: UHCCP Medicaid |
$161.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.58
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
45000254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
RPR LAC GREATER THAN 2.6CM(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
761P1663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.84 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$306.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.84
|
| Rate for Payer: Anthem Medicaid |
$155.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$303.19
|
| Rate for Payer: Healthspan PPO |
$357.06
|
| Rate for Payer: Humana Medicaid |
$155.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$273.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.13
|
| Rate for Payer: Molina Healthcare Passport |
$155.03
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$161.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.58
|
|
