|
RP LOCLZJ TUM SPECT 2 AREAS
|
Facility
|
IP
|
$2,294.00
|
|
|
Service Code
|
HCPCS 78831
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$688.20 |
| Max. Negotiated Rate |
$2,202.24 |
| Rate for Payer: Aetna Commercial |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,789.32
|
| Rate for Payer: Cash Price |
$1,147.00
|
| Rate for Payer: Cigna Commercial |
$1,904.02
|
| Rate for Payer: First Health Commercial |
$2,179.30
|
| Rate for Payer: Humana Commercial |
$1,949.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,881.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,692.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$688.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,018.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,720.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,835.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,995.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,582.86
|
| Rate for Payer: PHCS Commercial |
$2,202.24
|
| Rate for Payer: United Healthcare All Payer |
$2,018.72
|
|
|
RP LOCLZJ TUM SPECT W/CT 1
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
404T0011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$732.90 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,685.67
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
RP LOCLZJ TUM SPECT W/CT 1
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
404T0011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$840.15 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem Medicaid |
$840.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Humana KY Medicaid |
$840.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$857.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,685.67
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
RP LOCLZJ TUM SPECT W/CT 1
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 78830
|
| Hospital Charge Code |
404P0011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$494.52 |
| Rate for Payer: Ambetter Exchange |
$380.40
|
| Rate for Payer: Anthem Medicaid |
$369.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.48
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Humana Medicaid |
$369.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.11
|
| Rate for Payer: Molina Healthcare Passport |
$369.72
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$494.52
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.40
|
|
|
RPR AA HRN 1ST > 10 RDC
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 49595
|
| Hospital Charge Code |
76102830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$960.76 |
| Rate for Payer: Ambetter Exchange |
$739.05
|
| Rate for Payer: Anthem Medicaid |
$647.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$739.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$739.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$886.86
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Humana Medicaid |
$647.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$739.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$739.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.14
|
| Rate for Payer: Molina Healthcare Passport |
$647.20
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$960.76
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$653.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$739.05
|
|
|
RPR AA HRN 1ST > 10 RDC
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 49595
|
| Hospital Charge Code |
76102830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
RPR AA HRN 1ST > 10 RDC
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 49595
|
| Hospital Charge Code |
76102830
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$8,071.56 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,765.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,071.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,783.29
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Humana Medicare Advantage |
$5,765.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,918.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
76102826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
76102826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 49594
|
| Hospital Charge Code |
76102826
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$927.24 |
| Rate for Payer: Ambetter Exchange |
$713.26
|
| Rate for Payer: Anthem Medicaid |
$626.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$713.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$713.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$855.91
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Humana Medicaid |
$626.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$713.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$713.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$639.27
|
| Rate for Payer: Molina Healthcare Passport |
$626.74
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$927.24
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$633.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$713.26
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
76102827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$556.80 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.20
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
76102827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.46 |
| Max. Negotiated Rate |
$8,071.56 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem Medicaid |
$199.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,765.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,071.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,783.29
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Humana KY Medicaid |
$199.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,765.40
|
| Rate for Payer: Kentucky WC Medicaid |
$201.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,918.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.20
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
76102827
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$712.30 |
| Rate for Payer: Ambetter Exchange |
$547.92
|
| Rate for Payer: Anthem Medicaid |
$481.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$547.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$547.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$657.50
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Humana Medicaid |
$481.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$547.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$490.72
|
| Rate for Payer: Molina Healthcare Passport |
$481.10
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$712.30
|
| Rate for Payer: UHCCP Medicaid |
$203.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$485.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$547.92
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
76102825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.08 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
76102825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.25 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Ambetter Exchange |
$326.77
|
| Rate for Payer: Anthem Medicaid |
$286.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$326.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$326.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$392.12
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Humana Medicaid |
$286.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$326.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$292.26
|
| Rate for Payer: Molina Healthcare Passport |
$286.53
|
| Rate for Payer: Multiplan PHCS |
$213.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$424.80
|
| Rate for Payer: UHCCP Medicaid |
$124.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$289.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$326.77
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 49591
|
| Hospital Charge Code |
76102825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
OP
|
$1,545.00
|
|
|
Service Code
|
HCPCS 49596
|
| Hospital Charge Code |
76102835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.50 |
| Max. Negotiated Rate |
$1,483.20 |
| Rate for Payer: Aetna Commercial |
$1,189.65
|
| Rate for Payer: Anthem Medicaid |
$531.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.10
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$1,282.35
|
| Rate for Payer: First Health Commercial |
$1,467.75
|
| Rate for Payer: Humana Commercial |
$1,313.25
|
| Rate for Payer: Humana KY Medicaid |
$531.33
|
| Rate for Payer: Kentucky WC Medicaid |
$536.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,359.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,344.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.05
|
| Rate for Payer: PHCS Commercial |
$1,483.20
|
| Rate for Payer: United Healthcare All Payer |
$1,359.60
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 49596
|
| Hospital Charge Code |
76102835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.75 |
| Max. Negotiated Rate |
$1,276.47 |
| Rate for Payer: Ambetter Exchange |
$981.90
|
| Rate for Payer: Anthem Medicaid |
$859.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$981.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$981.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,178.28
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Humana Medicaid |
$859.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$981.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$877.17
|
| Rate for Payer: Molina Healthcare Passport |
$859.97
|
| Rate for Payer: Multiplan PHCS |
$927.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,276.47
|
| Rate for Payer: UHCCP Medicaid |
$540.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$868.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$981.90
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
76102834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$591.93 |
| Rate for Payer: Ambetter Exchange |
$455.33
|
| Rate for Payer: Anthem Medicaid |
$399.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$455.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$455.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$546.40
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Humana Medicaid |
$399.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$455.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.22
|
| Rate for Payer: Molina Healthcare Passport |
$399.24
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$591.93
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$455.33
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
76102834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 49592
|
| Hospital Charge Code |
76102834
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
IP
|
$1,545.00
|
|
|
Service Code
|
HCPCS 49596
|
| Hospital Charge Code |
76102835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.50 |
| Max. Negotiated Rate |
$1,483.20 |
| Rate for Payer: Aetna Commercial |
$1,189.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.10
|
| Rate for Payer: Cash Price |
$772.50
|
| Rate for Payer: Cigna Commercial |
$1,282.35
|
| Rate for Payer: First Health Commercial |
$1,467.75
|
| Rate for Payer: Humana Commercial |
$1,313.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,359.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,344.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.05
|
| Rate for Payer: PHCS Commercial |
$1,483.20
|
| Rate for Payer: United Healthcare All Payer |
$1,359.60
|
|
|
RPR AA HRN RCR > 10 NCR/STRN
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
76102841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.40
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
RPR AA HRN RCR > 10 NCR/STRN
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
76102841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem Medicaid |
$433.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Humana KY Medicaid |
$433.31
|
| Rate for Payer: Kentucky WC Medicaid |
$437.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.40
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
RPR AA HRN RCR > 10 NCR/STRN
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 49618
|
| Hospital Charge Code |
76102841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$1,547.49 |
| Rate for Payer: Ambetter Exchange |
$1,190.38
|
| Rate for Payer: Anthem Medicaid |
$1,042.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,190.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,428.46
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Humana Medicaid |
$1,042.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,190.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,063.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,042.28
|
| Rate for Payer: Multiplan PHCS |
$756.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,547.49
|
| Rate for Payer: UHCCP Medicaid |
$441.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,052.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,190.38
|
|
