|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
76100992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.98 |
| Max. Negotiated Rate |
$587.41 |
| Rate for Payer: Aetna Commercial |
$487.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.98
|
| Rate for Payer: Anthem Medicaid |
$278.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$535.59
|
| Rate for Payer: Healthspan PPO |
$587.41
|
| Rate for Payer: Humana Medicaid |
$278.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.02
|
| Rate for Payer: Molina Healthcare Passport |
$278.45
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$175.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.23
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
761P0992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.98 |
| Max. Negotiated Rate |
$587.41 |
| Rate for Payer: Aetna Commercial |
$487.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.98
|
| Rate for Payer: Anthem Medicaid |
$278.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$535.59
|
| Rate for Payer: Healthspan PPO |
$587.41
|
| Rate for Payer: Humana Medicaid |
$278.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.02
|
| Rate for Payer: Molina Healthcare Passport |
$278.45
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$175.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.23
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
76100992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem Medicaid |
$180.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Humana KY Medicaid |
$180.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$182.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.75
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
76100992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.75
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
RPR TDN/MUS F/A&/W SEC FR GRF
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
76100601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.68 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Anthem Medicaid |
$452.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,390.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,397.45
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$452.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.73
|
| Rate for Payer: Molina Healthcare Passport |
$452.68
|
| Rate for Payer: Multiplan PHCS |
$834.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$973.00
|
| Rate for Payer: UHCCP Medicaid |
$486.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.21
|
|
|
RPR TDN/MUS F/A&/W SEC FR GRF
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
76100601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$1,334.40 |
| Rate for Payer: Aetna Commercial |
$1,070.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,084.20
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,153.70
|
| Rate for Payer: First Health Commercial |
$1,320.50
|
| Rate for Payer: Humana Commercial |
$1,181.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,139.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,025.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,223.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$430.90
|
| Rate for Payer: PHCS Commercial |
$1,334.40
|
| Rate for Payer: United Healthcare All Payer |
$1,223.20
|
|
|
RPR TDN/MUS F/A&/W SEC FR GRF
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
76100601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,070.30
|
| Rate for Payer: Anthem Medicaid |
$478.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,084.20
|
| 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 |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,153.70
|
| Rate for Payer: First Health Commercial |
$1,320.50
|
| Rate for Payer: Humana Commercial |
$1,181.50
|
| Rate for Payer: Humana KY Medicaid |
$478.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$482.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,139.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,025.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$487.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,223.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$430.90
|
| Rate for Payer: PHCS Commercial |
$1,334.40
|
| Rate for Payer: United Healthcare All Payer |
$1,223.20
|
|
|
RPR TDN/MUS F/A&/W SEC FR GR(P
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
761P0601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.68 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Anthem Medicaid |
$452.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,390.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,397.45
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$452.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.73
|
| Rate for Payer: Molina Healthcare Passport |
$452.68
|
| Rate for Payer: Multiplan PHCS |
$834.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$973.00
|
| Rate for Payer: UHCCP Medicaid |
$486.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.21
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMU(P
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
761P0599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.05 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$976.24
|
| Rate for Payer: Anthem Medicaid |
$396.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,340.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,310.62
|
| Rate for Payer: Healthspan PPO |
$884.27
|
| Rate for Payer: Humana Medicaid |
$396.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$807.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.97
|
| Rate for Payer: Molina Healthcare Passport |
$396.05
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$938.00
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.01
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMUS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
76100599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.05 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$976.24
|
| Rate for Payer: Anthem Medicaid |
$396.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,340.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,310.62
|
| Rate for Payer: Healthspan PPO |
$884.27
|
| Rate for Payer: Humana Medicaid |
$396.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$807.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.97
|
| Rate for Payer: Molina Healthcare Passport |
$396.05
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$938.00
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.01
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMUS
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
76100599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$1,286.40 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.40
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMUS
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
76100599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem Medicaid |
$460.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Humana KY Medicaid |
$460.83
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$470.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.40
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76100600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
761P0600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$784.08
|
| Rate for Payer: Anthem Medicaid |
$271.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,110.31
|
| Rate for Payer: Healthspan PPO |
$710.21
|
| Rate for Payer: Humana Medicaid |
$271.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.46
|
| Rate for Payer: Molina Healthcare Passport |
$271.04
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.75
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76100600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76100600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$784.08
|
| Rate for Payer: Anthem Medicaid |
$271.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,110.31
|
| Rate for Payer: Healthspan PPO |
$710.21
|
| Rate for Payer: Humana Medicaid |
$271.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.46
|
| Rate for Payer: Molina Healthcare Passport |
$271.04
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.75
|
|
|
RPR TENDON EXT FOOT 1/2
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
76100993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.82
|
| Rate for Payer: Anthem Medicaid |
$202.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$507.24
|
| Rate for Payer: Healthspan PPO |
$565.21
|
| Rate for Payer: Humana Medicaid |
$202.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$380.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.84
|
| Rate for Payer: Molina Healthcare Passport |
$202.78
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$170.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.81
|
|
|
RPR TENDON EXT FOOT 1/2
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
76100993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
RPR TENDON EXT FOOT 1/2
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
76100993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| 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 |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
RPR TENDON EXT FOOT 1/2 (P
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
761P0993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.82
|
| Rate for Payer: Anthem Medicaid |
$202.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$507.24
|
| Rate for Payer: Healthspan PPO |
$565.21
|
| Rate for Payer: Humana Medicaid |
$202.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$380.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.84
|
| Rate for Payer: Molina Healthcare Passport |
$202.78
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$170.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.81
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
76100696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
76100696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.29 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,053.93
|
| Rate for Payer: Anthem Medicaid |
$374.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,299.88
|
| Rate for Payer: Healthspan PPO |
$954.64
|
| Rate for Payer: Humana Medicaid |
$374.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$911.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.78
|
| Rate for Payer: Molina Healthcare Passport |
$374.29
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$378.03
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
76100696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
761P0696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.29 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,053.93
|
| Rate for Payer: Anthem Medicaid |
$374.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,299.88
|
| Rate for Payer: Healthspan PPO |
$954.64
|
| Rate for Payer: Humana Medicaid |
$374.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$911.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.78
|
| Rate for Payer: Molina Healthcare Passport |
$374.29
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$378.03
|
|
|
RRAD 5F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
