|
RPR REM HERNIA INIT REDUCE(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
761P2017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$820.31 |
| Rate for Payer: Aetna Commercial |
$820.31
|
| Rate for Payer: Anthem Medicaid |
$351.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$764.71
|
| Rate for Payer: Healthspan PPO |
$691.78
|
| Rate for Payer: Humana Medicaid |
$351.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$727.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.77
|
| Rate for Payer: Molina Healthcare Passport |
$351.74
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.26
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.18
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
45000045
|
|
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 S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
45000045
|
|
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 S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem Medicaid |
$267.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Humana KY Medicaid |
$267.55
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$270.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.18
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna Commercial |
$244.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.96
|
| Rate for Payer: Anthem Medicaid |
$125.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$778.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$232.73
|
| Rate for Payer: Healthspan PPO |
$257.87
|
| Rate for Payer: Humana Medicaid |
$125.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.80
|
| Rate for Payer: Molina Healthcare Passport |
$125.29
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$544.60
|
| Rate for Payer: UHCCP Medicaid |
$71.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.54
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0C(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
761P0123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$244.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.96
|
| Rate for Payer: Anthem Medicaid |
$125.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$232.73
|
| Rate for Payer: Healthspan PPO |
$257.87
|
| Rate for Payer: Humana Medicaid |
$125.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.80
|
| Rate for Payer: Molina Healthcare Passport |
$125.29
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$71.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.54
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0C(T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
761T0123
|
|
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 S/N/A/GEN/TRK12.6-20.0C(T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
761T0123
|
|
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 S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$842.88 |
| Rate for Payer: Aetna Commercial |
$676.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.84
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cigna Commercial |
$728.74
|
| Rate for Payer: First Health Commercial |
$834.10
|
| Rate for Payer: Humana Commercial |
$746.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$772.64
|
| Rate for Payer: Ohio Health Group HMO |
$658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.18
|
| Rate for Payer: PHCS Commercial |
$842.88
|
| Rate for Payer: United Healthcare All Payer |
$772.64
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Professional
|
Both
|
$878.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.97
|
| Rate for Payer: Anthem Medicaid |
$158.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$878.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cigna Commercial |
$295.76
|
| Rate for Payer: Healthspan PPO |
$320.74
|
| Rate for Payer: Humana Medicaid |
$158.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.75
|
| Rate for Payer: Molina Healthcare Passport |
$158.58
|
| Rate for Payer: Multiplan PHCS |
$526.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$614.60
|
| Rate for Payer: UHCCP Medicaid |
$92.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.17
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$842.88 |
| Rate for Payer: Aetna Commercial |
$676.06
|
| Rate for Payer: Anthem Medicaid |
$301.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cigna Commercial |
$728.74
|
| Rate for Payer: First Health Commercial |
$834.10
|
| Rate for Payer: Humana Commercial |
$746.30
|
| Rate for Payer: Humana KY Medicaid |
$301.94
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$305.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$772.64
|
| Rate for Payer: Ohio Health Group HMO |
$658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.18
|
| Rate for Payer: PHCS Commercial |
$842.88
|
| Rate for Payer: United Healthcare All Payer |
$772.64
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
45000046
|
|
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 S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
45000046
|
|
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 S/N/A/GEN/TRK20.1-30.0C(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
761P0124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.97
|
| Rate for Payer: Anthem Medicaid |
$158.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$295.76
|
| Rate for Payer: Healthspan PPO |
$320.74
|
| Rate for Payer: Humana Medicaid |
$158.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.75
|
| Rate for Payer: Molina Healthcare Passport |
$158.58
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$92.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.17
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0C(T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
761T0124
|
|
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 S/N/A/GEN/TRK20.1-30.0C(T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
761T0124
|
|
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 S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Humana KY Medicaid |
$130.68
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$132.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$195.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.32
|
| Rate for Payer: Anthem Medicaid |
$97.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$186.34
|
| Rate for Payer: Healthspan PPO |
$206.58
|
| Rate for Payer: Humana Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.22
|
| Rate for Payer: Molina Healthcare Passport |
$97.27
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$41.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.24
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem Medicaid |
$216.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Humana KY Medicaid |
$216.66
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$218.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.30
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5C(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
761P0122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$195.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.32
|
| Rate for Payer: Anthem Medicaid |
$97.27
|
| 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 |
$186.34
|
| Rate for Payer: Healthspan PPO |
$206.58
|
| Rate for Payer: Humana Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.22
|
| Rate for Payer: Molina Healthcare Passport |
$97.27
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$41.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.24
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5C(T
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
761T0122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5C(T
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
761T0122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Humana KY Medicaid |
$130.68
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$132.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
