|
RPR AA HRN RCR > 10 RDC
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 49617
|
| Hospital Charge Code |
76102840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem Medicaid |
$311.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Humana KY Medicaid |
$311.23
|
| Rate for Payer: Kentucky WC Medicaid |
$314.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$317.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.45
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
RPR AA HRN RCR > 10 RDC
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 49617
|
| Hospital Charge Code |
76102840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.45
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
RPR AA HRN RCR > 10 RDC
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 49617
|
| Hospital Charge Code |
76102840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.75 |
| Max. Negotiated Rate |
$1,103.53 |
| Rate for Payer: Ambetter Exchange |
$848.87
|
| Rate for Payer: Anthem Medicaid |
$743.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$848.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$848.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,018.64
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Humana Medicaid |
$743.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$848.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$848.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$758.23
|
| Rate for Payer: Molina Healthcare Passport |
$743.36
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,103.53
|
| Rate for Payer: UHCCP Medicaid |
$316.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$750.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$848.87
|
|
|
RPR AA HRN RCR 3-10 NCR/STRN
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
76102839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
RPR AA HRN RCR 3-10 NCR/STRN
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
76102839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$1,067.11 |
| Rate for Payer: Ambetter Exchange |
$820.85
|
| Rate for Payer: Anthem Medicaid |
$721.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$820.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$820.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.02
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Humana Medicaid |
$721.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$820.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$736.04
|
| Rate for Payer: Molina Healthcare Passport |
$721.61
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.11
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$728.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$820.85
|
|
|
RPR AA HRN RCR 3-10 NCR/STRN
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 49616
|
| Hospital Charge Code |
76102839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem Medicaid |
$302.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Humana KY Medicaid |
$302.63
|
| Rate for Payer: Kentucky WC Medicaid |
$305.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
RPR AA HRN RCR 3-10 RDC
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
76102838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$794.01 |
| Rate for Payer: Ambetter Exchange |
$610.78
|
| Rate for Payer: Anthem Medicaid |
$536.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.94
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Humana Medicaid |
$536.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$547.63
|
| Rate for Payer: Molina Healthcare Passport |
$536.89
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.01
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$542.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.78
|
|
|
RPR AA HRN RCR 3-10 RDC
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
76102838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.97 |
| Max. Negotiated Rate |
$8,071.56 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,765.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| 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 |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$5,765.40
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,918.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
RPR AA HRN RCR 3-10 RDC
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 49615
|
| Hospital Charge Code |
76102838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
76102837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$710.24 |
| Rate for Payer: Ambetter Exchange |
$546.34
|
| Rate for Payer: Anthem Medicaid |
$480.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$546.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$546.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$655.61
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Humana Medicaid |
$480.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$546.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$489.63
|
| Rate for Payer: Molina Healthcare Passport |
$480.03
|
| Rate for Payer: Multiplan PHCS |
$357.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$710.24
|
| Rate for Payer: UHCCP Medicaid |
$208.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$484.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$546.34
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
76102837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.55
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
HCPCS 49614
|
| Hospital Charge Code |
76102837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.62 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem Medicaid |
$204.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| 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 |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Humana KY Medicaid |
$204.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.55
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
RPR AA HRN RCR < 3 RDC
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
76102836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.04 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$342.65
|
| Rate for Payer: Anthem Medicaid |
$153.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.10
|
| 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 |
$222.50
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$369.35
|
| Rate for Payer: First Health Commercial |
$422.75
|
| Rate for Payer: Humana Commercial |
$378.25
|
| Rate for Payer: Humana KY Medicaid |
$153.04
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$154.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.60
|
| Rate for Payer: Ohio Health Group HMO |
$333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.05
|
| Rate for Payer: PHCS Commercial |
$427.20
|
| Rate for Payer: United Healthcare All Payer |
$391.60
|
|
|
RPR AA HRN RCR < 3 RDC
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
76102836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.50 |
| Max. Negotiated Rate |
$427.20 |
| Rate for Payer: Aetna Commercial |
$342.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.10
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cigna Commercial |
$369.35
|
| Rate for Payer: First Health Commercial |
$422.75
|
| Rate for Payer: Humana Commercial |
$378.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$391.60
|
| Rate for Payer: Ohio Health Group HMO |
$333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.05
|
| Rate for Payer: PHCS Commercial |
$427.20
|
| Rate for Payer: United Healthcare All Payer |
$391.60
|
|
|
RPR AA HRN RCR < 3 RDC
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 49613
|
| Hospital Charge Code |
76102836
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.75 |
| Max. Negotiated Rate |
$522.74 |
| Rate for Payer: Ambetter Exchange |
$402.11
|
| Rate for Payer: Anthem Medicaid |
$353.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.53
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Cash Price |
$222.50
|
| Rate for Payer: Humana Medicaid |
$353.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.46
|
| Rate for Payer: Molina Healthcare Passport |
$353.39
|
| Rate for Payer: Multiplan PHCS |
$267.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.74
|
| Rate for Payer: UHCCP Medicaid |
$155.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.11
|
|
|
RPR/ADV FLXR TDN WFR GRAFT
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
76100690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$876.95 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem Medicaid |
$876.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Humana KY Medicaid |
$876.95
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$885.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$894.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,218.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,759.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
RPR/ADV FLXR TDN WFR GRAFT
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
76100690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$765.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,218.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,759.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
RPR/ADV FLXR TDN WFR GRAFT
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
76100690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$1,588.57 |
| Rate for Payer: Aetna Commercial |
$1,293.08
|
| Rate for Payer: Ambetter Exchange |
$933.69
|
| Rate for Payer: Anthem Medicaid |
$484.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$933.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$933.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,120.43
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,588.57
|
| Rate for Payer: Healthspan PPO |
$1,171.25
|
| Rate for Payer: Humana Medicaid |
$484.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,122.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$933.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.03
|
| Rate for Payer: Molina Healthcare Passport |
$484.34
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,213.80
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$933.69
|
|
|
RPR/ADV FLXR TDN WFR GRAFT(P
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 26358
|
| Hospital Charge Code |
761P0690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.34 |
| Max. Negotiated Rate |
$1,588.57 |
| Rate for Payer: Aetna Commercial |
$1,293.08
|
| Rate for Payer: Ambetter Exchange |
$933.69
|
| Rate for Payer: Anthem Medicaid |
$484.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$933.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$933.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,120.43
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,588.57
|
| Rate for Payer: Healthspan PPO |
$1,171.25
|
| Rate for Payer: Humana Medicaid |
$484.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,122.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$933.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.03
|
| Rate for Payer: Molina Healthcare Passport |
$484.34
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,213.80
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$933.69
|
|
|
RPR/ADV FLXR TDN W/O FR GRF(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
761P0688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.39 |
| Max. Negotiated Rate |
$1,764.28 |
| Rate for Payer: Aetna Commercial |
$1,473.06
|
| Rate for Payer: Ambetter Exchange |
$755.70
|
| Rate for Payer: Anthem Medicaid |
$430.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$755.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$906.84
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,764.28
|
| Rate for Payer: Healthspan PPO |
$1,334.28
|
| Rate for Payer: Humana Medicaid |
$430.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,311.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$755.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$439.00
|
| Rate for Payer: Molina Healthcare Passport |
$430.39
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$982.41
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$755.70
|
|
|
RPR/ADV FLXR TDN W/O FR GRFT
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
76100688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
RPR/ADV FLXR TDN W/O FR GRFT
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
76100688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
RPR/ADV FLXR TDN W/O FR GRFT
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 26356
|
| Hospital Charge Code |
76100688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.39 |
| Max. Negotiated Rate |
$1,764.28 |
| Rate for Payer: Aetna Commercial |
$1,473.06
|
| Rate for Payer: Ambetter Exchange |
$755.70
|
| Rate for Payer: Anthem Medicaid |
$430.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$755.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$906.84
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,764.28
|
| Rate for Payer: Healthspan PPO |
$1,334.28
|
| Rate for Payer: Humana Medicaid |
$430.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,311.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$755.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$439.00
|
| Rate for Payer: Molina Healthcare Passport |
$430.39
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$982.41
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$755.70
|
|
|
RPR/ADV FLXR TDN WO FR GRFT
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
76100689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.85 |
| Max. Negotiated Rate |
$1,495.23 |
| Rate for Payer: Aetna Commercial |
$1,223.43
|
| Rate for Payer: Ambetter Exchange |
$845.86
|
| Rate for Payer: Anthem Medicaid |
$444.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$845.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$845.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,015.03
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,495.23
|
| Rate for Payer: Healthspan PPO |
$1,108.16
|
| Rate for Payer: Humana Medicaid |
$444.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,051.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$845.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$845.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.75
|
| Rate for Payer: Molina Healthcare Passport |
$444.85
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,099.62
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$845.86
|
|
|
RPR/ADV FLXR TDN WO FR GRFT
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
76100689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
