|
RPR PARASTOMAL HERNIA RDC
|
Facility
|
IP
|
$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 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: 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: 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 HRNA NCR/STRN
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 49622
|
| Hospital Charge Code |
76102843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem Medicaid |
$321.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Humana KY Medicaid |
$321.55
|
| Rate for Payer: Kentucky WC Medicaid |
$324.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
RPR PARASTOMAL HRNA NCR/STRN
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 49622
|
| Hospital Charge Code |
76102843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$1,163.58 |
| Rate for Payer: Ambetter Exchange |
$895.06
|
| Rate for Payer: Anthem Medicaid |
$770.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$895.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$895.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,074.07
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Humana Medicaid |
$770.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$895.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$895.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$785.98
|
| Rate for Payer: Molina Healthcare Passport |
$770.57
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,163.58
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$778.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$895.06
|
|
|
RPR PARASTOMAL HRNA NCR/STRN
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 49622
|
| Hospital Charge Code |
76102843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
RPR QUAL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
RPR QUAL
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna Commercial |
$3.32
|
| Rate for Payer: First Health Commercial |
$3.80
|
| Rate for Payer: Humana Commercial |
$3.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.76
|
| Rate for Payer: PHCS Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Payer |
$3.52
|
|
|
RPR QUAL
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.98 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cigna Commercial |
$3.32
|
| Rate for Payer: First Health Commercial |
$3.80
|
| Rate for Payer: Humana Commercial |
$3.40
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.76
|
| Rate for Payer: PHCS Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Payer |
$3.52
|
|
|
RPR QUAL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
30001107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
RPR QUANT
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
30001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem Medicaid |
$4.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Humana KY Medicaid |
$4.40
|
| Rate for Payer: Humana Medicare Advantage |
$4.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
RPR QUANT
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
30001108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
RPR REM HERNIA INIT REDUCE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
76102017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
RPR REM HERNIA INIT REDUCE
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
76102017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$820.31 |
| Rate for Payer: Aetna Commercial |
$820.31
|
| Rate for Payer: Ambetter Exchange |
$553.98
|
| Rate for Payer: Anthem Medicaid |
$351.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$553.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$553.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$664.78
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$764.71
|
| Rate for Payer: Healthspan PPO |
$691.78
|
| Rate for Payer: Humana Medicaid |
$351.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$727.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$553.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.77
|
| Rate for Payer: Molina Healthcare Passport |
$351.74
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.17
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$553.98
|
|
|
RPR REM HERNIA INIT REDUCE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
76102017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
RPR REM HERNIA INIT REDUCE(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
761P2017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$820.31 |
| Rate for Payer: Aetna Commercial |
$820.31
|
| Rate for Payer: Ambetter Exchange |
$553.98
|
| Rate for Payer: Anthem Medicaid |
$351.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$553.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$553.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$664.78
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$764.71
|
| Rate for Payer: Healthspan PPO |
$691.78
|
| Rate for Payer: Humana Medicaid |
$351.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$727.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$553.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.77
|
| Rate for Payer: Molina Healthcare Passport |
$351.74
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.17
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$553.98
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.22 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Humana KY Medicaid |
$278.22
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$281.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$485.40 |
| Rate for Payer: Aetna Commercial |
$244.37
|
| Rate for Payer: Ambetter Exchange |
$90.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.96
|
| Rate for Payer: Anthem Medicaid |
$125.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.37
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$232.73
|
| Rate for Payer: Healthspan PPO |
$257.87
|
| Rate for Payer: Humana Medicaid |
$125.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.80
|
| Rate for Payer: Molina Healthcare Passport |
$125.29
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.40
|
| Rate for Payer: UHCCP Medicaid |
$71.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.31
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
45000045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0C(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
761P0123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$257.87 |
| Rate for Payer: Aetna Commercial |
$244.37
|
| Rate for Payer: Ambetter Exchange |
$90.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.96
|
| Rate for Payer: Anthem Medicaid |
$125.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.37
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$232.73
|
| Rate for Payer: Healthspan PPO |
$257.87
|
| Rate for Payer: Humana Medicaid |
$125.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.80
|
| Rate for Payer: Molina Healthcare Passport |
$125.29
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.40
|
| Rate for Payer: UHCCP Medicaid |
$71.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.31
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0C(T
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
761T0123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0C(T
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
761T0123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$545.40 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Ambetter Exchange |
$111.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.97
|
| Rate for Payer: Anthem Medicaid |
$158.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$134.04
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$295.76
|
| Rate for Payer: Healthspan PPO |
$320.74
|
| Rate for Payer: Humana Medicaid |
$158.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.75
|
| Rate for Payer: Molina Healthcare Passport |
$158.58
|
| Rate for Payer: Multiplan PHCS |
$545.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.21
|
| Rate for Payer: UHCCP Medicaid |
$92.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.70
|
|
