|
RPR LAC 2.5CM OR LESS
|
Facility
|
IP
|
$1,089.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
76101661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.75 |
| Max. Negotiated Rate |
$1,045.59 |
| Rate for Payer: Aetna Commercial |
$838.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.54
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cigna Commercial |
$904.00
|
| Rate for Payer: First Health Commercial |
$1,034.70
|
| Rate for Payer: Humana Commercial |
$925.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.46
|
| Rate for Payer: Ohio Health Group HMO |
$816.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.52
|
| Rate for Payer: PHCS Commercial |
$1,045.59
|
| Rate for Payer: United Healthcare All Payer |
$958.46
|
|
|
RPR LAC 2.5CM OR LESS
|
Facility
|
IP
|
$514.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
45000252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.04
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cigna Commercial |
$426.75
|
| Rate for Payer: First Health Commercial |
$488.45
|
| Rate for Payer: Humana Commercial |
$437.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.46
|
| Rate for Payer: Ohio Health Group HMO |
$385.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.77
|
| Rate for Payer: PHCS Commercial |
$493.59
|
| Rate for Payer: United Healthcare All Payer |
$452.46
|
|
|
RPR LAC 2.5CM OR LESS
|
Facility
|
OP
|
$514.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
45000252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$176.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cigna Commercial |
$426.75
|
| Rate for Payer: First Health Commercial |
$488.45
|
| Rate for Payer: Humana Commercial |
$437.04
|
| Rate for Payer: Humana KY Medicaid |
$176.82
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$178.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.46
|
| Rate for Payer: Ohio Health Group HMO |
$385.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.77
|
| Rate for Payer: PHCS Commercial |
$493.59
|
| Rate for Payer: United Healthcare All Payer |
$452.46
|
|
|
RPR LAC 2.5CM OR LESS
|
Professional
|
Both
|
$1,089.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
76101661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$653.50 |
| Rate for Payer: Aetna Commercial |
$202.90
|
| Rate for Payer: Ambetter Exchange |
$145.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.45
|
| Rate for Payer: Anthem Medicaid |
$85.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.11
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cash Price |
$544.58
|
| Rate for Payer: Cigna Commercial |
$188.30
|
| Rate for Payer: Healthspan PPO |
$261.39
|
| Rate for Payer: Humana Medicaid |
$85.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.67
|
| Rate for Payer: Molina Healthcare Passport |
$85.95
|
| Rate for Payer: Multiplan PHCS |
$653.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.62
|
| Rate for Payer: UHCCP Medicaid |
$94.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.09
|
|
|
RPR LAC 2.5CM OR LESS(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
761P1661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$202.90
|
| Rate for Payer: Ambetter Exchange |
$145.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.45
|
| Rate for Payer: Anthem Medicaid |
$85.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.11
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$188.30
|
| Rate for Payer: Healthspan PPO |
$261.39
|
| Rate for Payer: Humana Medicaid |
$85.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.67
|
| Rate for Payer: Molina Healthcare Passport |
$85.95
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.62
|
| Rate for Payer: UHCCP Medicaid |
$94.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.09
|
|
|
RPR LAC 2.5CM OR LESS(T
|
Facility
|
OP
|
$514.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
761T1661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$176.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cigna Commercial |
$426.75
|
| Rate for Payer: First Health Commercial |
$488.45
|
| Rate for Payer: Humana Commercial |
$437.04
|
| Rate for Payer: Humana KY Medicaid |
$176.82
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$178.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.46
|
| Rate for Payer: Ohio Health Group HMO |
$385.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.77
|
| Rate for Payer: PHCS Commercial |
$493.59
|
| Rate for Payer: United Healthcare All Payer |
$452.46
|
|
|
RPR LAC 2.5CM OR LESS(T
|
Facility
|
IP
|
$514.16
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
761T1661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$493.59 |
| Rate for Payer: Aetna Commercial |
$395.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.04
|
| Rate for Payer: Cash Price |
$257.08
|
| Rate for Payer: Cigna Commercial |
$426.75
|
| Rate for Payer: First Health Commercial |
$488.45
|
| Rate for Payer: Humana Commercial |
$437.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.46
|
| Rate for Payer: Ohio Health Group HMO |
$385.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.77
|
| Rate for Payer: PHCS Commercial |
$493.59
|
| Rate for Payer: United Healthcare All Payer |
$452.46
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
IP
|
$1,170.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
45000254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.15 |
| Max. Negotiated Rate |
$1,123.68 |
| Rate for Payer: Aetna Commercial |
$901.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.99
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cigna Commercial |
$971.51
|
| Rate for Payer: First Health Commercial |
$1,111.97
|
| Rate for Payer: Humana Commercial |
$994.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,030.04
|
| Rate for Payer: Ohio Health Group HMO |
$877.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.64
|
| Rate for Payer: PHCS Commercial |
$1,123.68
|
| Rate for Payer: United Healthcare All Payer |
$1,030.04
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Professional
|
Both
|
$2,120.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
76101663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.84 |
| Max. Negotiated Rate |
$1,272.30 |
| Rate for Payer: Aetna Commercial |
$306.72
|
| Rate for Payer: Ambetter Exchange |
$197.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.84
|
| Rate for Payer: Anthem Medicaid |
$155.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.69
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cigna Commercial |
$303.19
|
| Rate for Payer: Healthspan PPO |
$357.06
|
| Rate for Payer: Humana Medicaid |
$155.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$273.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.13
|
| Rate for Payer: Molina Healthcare Passport |
$155.03
|
| Rate for Payer: Multiplan PHCS |
$1,272.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.41
|
| Rate for Payer: UHCCP Medicaid |
$161.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.24
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
OP
|
$2,120.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
76101663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$2,035.68 |
| Rate for Payer: Aetna Commercial |
$1,632.79
|
| Rate for Payer: Anthem Medicaid |
$729.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: First Health Commercial |
$2,014.47
|
| Rate for Payer: Humana Commercial |
$1,802.42
|
| Rate for Payer: Humana KY Medicaid |
$729.24
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$736.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,866.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,844.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.14
|
| Rate for Payer: PHCS Commercial |
$2,035.68
|
| Rate for Payer: United Healthcare All Payer |
$1,866.04
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
OP
|
$1,170.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
45000254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$1,123.68 |
| Rate for Payer: Aetna Commercial |
$901.28
|
| Rate for Payer: Anthem Medicaid |
$402.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cigna Commercial |
$971.51
|
| Rate for Payer: First Health Commercial |
$1,111.97
|
| Rate for Payer: Humana Commercial |
$994.92
|
| Rate for Payer: Humana KY Medicaid |
$402.53
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$406.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,030.04
|
| Rate for Payer: Ohio Health Group HMO |
$877.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.64
|
| Rate for Payer: PHCS Commercial |
$1,123.68
|
| Rate for Payer: United Healthcare All Payer |
$1,030.04
|
|
|
RPR LAC GREATER THAN 2.6CM
|
Facility
|
IP
|
$2,120.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
76101663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.15 |
| Max. Negotiated Rate |
$2,035.68 |
| Rate for Payer: Aetna Commercial |
$1,632.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.99
|
| Rate for Payer: Cash Price |
$1,060.25
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: First Health Commercial |
$2,014.47
|
| Rate for Payer: Humana Commercial |
$1,802.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,866.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,844.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.14
|
| Rate for Payer: PHCS Commercial |
$2,035.68
|
| Rate for Payer: United Healthcare All Payer |
$1,866.04
|
|
|
RPR LAC GREATER THAN 2.6CM(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
761P1663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.84 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$306.72
|
| Rate for Payer: Ambetter Exchange |
$197.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.84
|
| Rate for Payer: Anthem Medicaid |
$155.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.69
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$303.19
|
| Rate for Payer: Healthspan PPO |
$357.06
|
| Rate for Payer: Humana Medicaid |
$155.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$273.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.13
|
| Rate for Payer: Molina Healthcare Passport |
$155.03
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.41
|
| Rate for Payer: UHCCP Medicaid |
$161.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.24
|
|
|
RPR LAC GREATER THAN 2.6CM(T
|
Facility
|
OP
|
$1,170.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
761T1663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$1,123.68 |
| Rate for Payer: Aetna Commercial |
$901.28
|
| Rate for Payer: Anthem Medicaid |
$402.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cigna Commercial |
$971.51
|
| Rate for Payer: First Health Commercial |
$1,111.97
|
| Rate for Payer: Humana Commercial |
$994.92
|
| Rate for Payer: Humana KY Medicaid |
$402.53
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$406.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,030.04
|
| Rate for Payer: Ohio Health Group HMO |
$877.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.64
|
| Rate for Payer: PHCS Commercial |
$1,123.68
|
| Rate for Payer: United Healthcare All Payer |
$1,030.04
|
|
|
RPR LAC GREATER THAN 2.6CM(T
|
Facility
|
IP
|
$1,170.50
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
761T1663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.15 |
| Max. Negotiated Rate |
$1,123.68 |
| Rate for Payer: Aetna Commercial |
$901.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.99
|
| Rate for Payer: Cash Price |
$585.25
|
| Rate for Payer: Cigna Commercial |
$971.51
|
| Rate for Payer: First Health Commercial |
$1,111.97
|
| Rate for Payer: Humana Commercial |
$994.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,030.04
|
| Rate for Payer: Ohio Health Group HMO |
$877.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.64
|
| Rate for Payer: PHCS Commercial |
$1,123.68
|
| Rate for Payer: United Healthcare All Payer |
$1,030.04
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
76100835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
76100835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.23 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$990.81
|
| Rate for Payer: Ambetter Exchange |
$644.99
|
| Rate for Payer: Anthem Medicaid |
$547.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.99
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,085.36
|
| Rate for Payer: Healthspan PPO |
$897.46
|
| Rate for Payer: Humana Medicaid |
$547.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$558.17
|
| Rate for Payer: Molina Healthcare Passport |
$547.23
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$838.49
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.99
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
76100835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
RPR LIGAMENT +/- CAP KNEE COLL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27405
|
| Hospital Charge Code |
761P0835
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.23 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$990.81
|
| Rate for Payer: Ambetter Exchange |
$644.99
|
| Rate for Payer: Anthem Medicaid |
$547.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.99
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,085.36
|
| Rate for Payer: Healthspan PPO |
$897.46
|
| Rate for Payer: Humana Medicaid |
$547.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$558.17
|
| Rate for Payer: Molina Healthcare Passport |
$547.23
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$838.49
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.99
|
|
|
RPR OF BLEPHAROPTOSIS
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
76102395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
RPR OF BLEPHAROPTOSIS
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
76102395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$682.40 |
| Rate for Payer: Aetna Commercial |
$682.40
|
| Rate for Payer: Ambetter Exchange |
$464.39
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$464.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$464.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$557.27
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$662.14
|
| Rate for Payer: Healthspan PPO |
$605.32
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$464.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.71
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$464.39
|
|
|
RPR OF BLEPHAROPTOSIS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
76102395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$4,878.06 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,484.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,878.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,703.85
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$3,484.33
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,181.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
RPR OF BLEPHAROPTOSIS(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 67906
|
| Hospital Charge Code |
761P2395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$682.40 |
| Rate for Payer: Aetna Commercial |
$682.40
|
| Rate for Payer: Ambetter Exchange |
$464.39
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$464.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$464.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$557.27
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$662.14
|
| Rate for Payer: Healthspan PPO |
$605.32
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$464.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.71
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$464.39
|
|
|
RPR PARASTOMAL HERNIA RDC
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
HCPCS 49621
|
| Hospital Charge Code |
76102842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem Medicaid |
$263.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Humana KY Medicaid |
$263.08
|
| Rate for Payer: Kentucky WC Medicaid |
$265.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.85
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
RPR PARASTOMAL HERNIA RDC
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 49621
|
| Hospital Charge Code |
76102842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$934.78 |
| Rate for Payer: Ambetter Exchange |
$719.06
|
| Rate for Payer: Anthem Medicaid |
$624.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$719.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$719.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$862.87
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Humana Medicaid |
$624.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$719.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$719.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$636.53
|
| Rate for Payer: Molina Healthcare Passport |
$624.05
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.78
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$630.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$719.06
|
|
