|
RPR/ADV FLXR TDN WO FR GRFT
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
76100689
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| 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: 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 |
$690.00
|
| 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
|
|
|
RPR/ADV FLXR TDN WO FR GRFT(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 26357
|
| Hospital Charge Code |
761P0689
|
|
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 TDN WNTC SUPF TDN PRIM
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
76100691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.03 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem Medicaid |
$576.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| 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 |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Humana KY Medicaid |
$576.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$581.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$587.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,457.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,155.75
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
76100691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.50 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$502.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,457.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,155.75
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
76100691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.33 |
| Max. Negotiated Rate |
$1,356.86 |
| Rate for Payer: Aetna Commercial |
$1,080.76
|
| Rate for Payer: Ambetter Exchange |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$404.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$725.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$870.41
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,356.86
|
| Rate for Payer: Healthspan PPO |
$978.94
|
| Rate for Payer: Humana Medicaid |
$404.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$725.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.42
|
| Rate for Payer: Molina Healthcare Passport |
$404.33
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$942.94
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$725.34
|
|
|
RPR/ADV TDN WNTC SUPF TDN PRIM
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 26370
|
| Hospital Charge Code |
761P0691
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.33 |
| Max. Negotiated Rate |
$1,356.86 |
| Rate for Payer: Aetna Commercial |
$1,080.76
|
| Rate for Payer: Ambetter Exchange |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$404.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$725.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$870.41
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,356.86
|
| Rate for Payer: Healthspan PPO |
$978.94
|
| Rate for Payer: Humana Medicaid |
$404.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$725.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$412.42
|
| Rate for Payer: Molina Healthcare Passport |
$404.33
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$942.94
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$408.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$725.34
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
761P0692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.77 |
| Max. Negotiated Rate |
$1,485.53 |
| Rate for Payer: Aetna Commercial |
$1,192.32
|
| Rate for Payer: Ambetter Exchange |
$814.84
|
| Rate for Payer: Anthem Medicaid |
$435.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$814.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$814.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$977.81
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,485.53
|
| Rate for Payer: Healthspan PPO |
$1,079.99
|
| Rate for Payer: Humana Medicaid |
$435.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$814.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$814.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$444.49
|
| Rate for Payer: Molina Healthcare Passport |
$435.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,059.29
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$440.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$814.84
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
76100692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.77 |
| Max. Negotiated Rate |
$1,485.53 |
| Rate for Payer: Aetna Commercial |
$1,192.32
|
| Rate for Payer: Ambetter Exchange |
$814.84
|
| Rate for Payer: Anthem Medicaid |
$435.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$814.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$814.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$977.81
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,485.53
|
| Rate for Payer: Healthspan PPO |
$1,079.99
|
| Rate for Payer: Humana Medicaid |
$435.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$814.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$814.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$444.49
|
| Rate for Payer: Molina Healthcare Passport |
$435.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,059.29
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$440.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$814.84
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
76100692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RPR/ADV TDNWNTC SUPFTDN WOFREE
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26373
|
| Hospital Charge Code |
76100692
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
76102394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.50 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.15
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
76102394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$596.67 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.15
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
76102394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna Commercial |
$776.67
|
| Rate for Payer: Ambetter Exchange |
$547.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.96
|
| Rate for Payer: Anthem Medicaid |
$397.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$547.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$547.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$656.56
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$732.79
|
| Rate for Payer: Healthspan PPO |
$838.96
|
| Rate for Payer: Humana Medicaid |
$397.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$751.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$547.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.00
|
| Rate for Payer: Molina Healthcare Passport |
$397.06
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$711.27
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$547.13
|
|
|
RPR BLEPH RESCJ/ADVMNT XEXT(P
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 67904
|
| Hospital Charge Code |
761P2394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna Commercial |
$776.67
|
| Rate for Payer: Ambetter Exchange |
$547.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.96
|
| Rate for Payer: Anthem Medicaid |
$397.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$547.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$547.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$656.56
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$732.79
|
| Rate for Payer: Healthspan PPO |
$838.96
|
| Rate for Payer: Humana Medicaid |
$397.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$751.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$547.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.00
|
| Rate for Payer: Molina Healthcare Passport |
$397.06
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$711.27
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$547.13
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
76101133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
761P1133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.74 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$945.48
|
| Rate for Payer: Ambetter Exchange |
$680.93
|
| Rate for Payer: Anthem Medicaid |
$413.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$680.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.12
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$957.61
|
| Rate for Payer: Healthspan PPO |
$797.34
|
| Rate for Payer: Humana Medicaid |
$413.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$680.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.01
|
| Rate for Payer: Molina Healthcare Passport |
$413.74
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$885.21
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$417.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$680.93
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
76101133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.74 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$945.48
|
| Rate for Payer: Ambetter Exchange |
$680.93
|
| Rate for Payer: Anthem Medicaid |
$413.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$680.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.12
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$957.61
|
| Rate for Payer: Healthspan PPO |
$797.34
|
| Rate for Payer: Humana Medicaid |
$413.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$680.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$680.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.01
|
| Rate for Payer: Molina Healthcare Passport |
$413.74
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$885.21
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$417.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$680.93
|
|
|
RPR CHOANAL ATRESIA INTRANASAL
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30540
|
| Hospital Charge Code |
76101133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
76100914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.64 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| 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 |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
76100914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$975.77 |
| Rate for Payer: Aetna Commercial |
$874.93
|
| Rate for Payer: Ambetter Exchange |
$522.33
|
| Rate for Payer: Anthem Medicaid |
$444.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$522.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.80
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$975.77
|
| Rate for Payer: Healthspan PPO |
$792.50
|
| Rate for Payer: Humana Medicaid |
$444.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$522.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$452.96
|
| Rate for Payer: Molina Healthcare Passport |
$444.08
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$679.03
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$522.33
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
76100914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
RPR DIS LIGM ANK BTH COLTL LIG
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 27696
|
| Hospital Charge Code |
761P0914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.25 |
| Max. Negotiated Rate |
$975.77 |
| Rate for Payer: Aetna Commercial |
$874.93
|
| Rate for Payer: Ambetter Exchange |
$522.33
|
| Rate for Payer: Anthem Medicaid |
$444.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$522.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.80
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$975.77
|
| Rate for Payer: Healthspan PPO |
$792.50
|
| Rate for Payer: Humana Medicaid |
$444.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$522.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$452.96
|
| Rate for Payer: Molina Healthcare Passport |
$444.08
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$679.03
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$522.33
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 35001
|
| Hospital Charge Code |
76101354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 35103
|
| Hospital Charge Code |
76101362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem Medicaid |
$864.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Humana KY Medicaid |
$864.91
|
| Rate for Payer: Kentucky WC Medicaid |
$873.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.35
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
RPR/EXC ANEURYSM/PSEUDO PART
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 35151
|
| Hospital Charge Code |
76101367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$945.88 |
| Max. Negotiated Rate |
$2,216.70 |
| Rate for Payer: Aetna Commercial |
$2,216.70
|
| Rate for Payer: Ambetter Exchange |
$1,161.26
|
| Rate for Payer: Anthem Medicaid |
$945.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,161.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,161.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,393.51
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,129.02
|
| Rate for Payer: Healthspan PPO |
$2,179.45
|
| Rate for Payer: Humana Medicaid |
$945.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,715.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,161.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$964.80
|
| Rate for Payer: Molina Healthcare Passport |
$945.88
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,509.64
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$955.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,161.26
|
|
