|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.70 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$790.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.21
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.61 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem Medicaid |
$312.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Humana KY Medicaid |
$312.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$315.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$790.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.21
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0C(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
761P0124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$320.74 |
| 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 |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| 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 |
$240.00
|
| 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
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0C(T
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
761T0124
|
|
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/TRK20.1-30.0C(T
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
761T0124
|
|
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/AX/GEN/TRK7.6-12.5CM
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$392.40 |
| Rate for Payer: Aetna Commercial |
$195.73
|
| Rate for Payer: Ambetter Exchange |
$69.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.32
|
| Rate for Payer: Anthem Medicaid |
$97.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.74
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$186.34
|
| Rate for Payer: Healthspan PPO |
$206.58
|
| Rate for Payer: Humana Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.22
|
| Rate for Payer: Molina Healthcare Passport |
$97.27
|
| Rate for Payer: Multiplan PHCS |
$392.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.71
|
| Rate for Payer: UHCCP Medicaid |
$41.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.78
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Humana KY Medicaid |
$138.94
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$627.84 |
| Rate for Payer: Aetna Commercial |
$503.58
|
| Rate for Payer: Anthem Medicaid |
$224.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$542.82
|
| Rate for Payer: First Health Commercial |
$621.30
|
| Rate for Payer: Humana Commercial |
$555.90
|
| Rate for Payer: Humana KY Medicaid |
$224.91
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$227.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$536.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$482.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$229.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$575.52
|
| Rate for Payer: Ohio Health Group HMO |
$490.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$451.26
|
| Rate for Payer: PHCS Commercial |
$627.84
|
| Rate for Payer: United Healthcare All Payer |
$575.52
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$627.84 |
| Rate for Payer: Aetna Commercial |
$503.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.12
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$542.82
|
| Rate for Payer: First Health Commercial |
$621.30
|
| Rate for Payer: Humana Commercial |
$555.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$536.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$482.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$575.52
|
| Rate for Payer: Ohio Health Group HMO |
$490.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$451.26
|
| Rate for Payer: PHCS Commercial |
$627.84
|
| Rate for Payer: United Healthcare All Payer |
$575.52
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5C(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
761P0122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$206.58 |
| Rate for Payer: Aetna Commercial |
$195.73
|
| Rate for Payer: Ambetter Exchange |
$69.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.32
|
| Rate for Payer: Anthem Medicaid |
$97.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.74
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$186.34
|
| Rate for Payer: Healthspan PPO |
$206.58
|
| Rate for Payer: Humana Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.22
|
| Rate for Payer: Molina Healthcare Passport |
$97.27
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.71
|
| Rate for Payer: UHCCP Medicaid |
$41.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.78
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5C(T
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
761T0122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5C(T
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
761T0122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Humana KY Medicaid |
$138.94
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
76100992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.25
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
76100992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.98 |
| Max. Negotiated Rate |
$587.41 |
| Rate for Payer: Aetna Commercial |
$487.42
|
| Rate for Payer: Ambetter Exchange |
$310.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.98
|
| Rate for Payer: Anthem Medicaid |
$278.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$535.59
|
| Rate for Payer: Healthspan PPO |
$587.41
|
| Rate for Payer: Humana Medicaid |
$278.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.02
|
| Rate for Payer: Molina Healthcare Passport |
$278.45
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.58
|
| Rate for Payer: UHCCP Medicaid |
$175.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.45
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
76100992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.55 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem Medicaid |
$180.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| 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 |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Humana KY Medicaid |
$180.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$182.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.25
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
RPR TDN FLXR FOOT 1/2 WO FRGRG
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 28200
|
| Hospital Charge Code |
761P0992
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.98 |
| Max. Negotiated Rate |
$587.41 |
| Rate for Payer: Aetna Commercial |
$487.42
|
| Rate for Payer: Ambetter Exchange |
$310.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.98
|
| Rate for Payer: Anthem Medicaid |
$278.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$535.59
|
| Rate for Payer: Healthspan PPO |
$587.41
|
| Rate for Payer: Humana Medicaid |
$278.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.02
|
| Rate for Payer: Molina Healthcare Passport |
$278.45
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.58
|
| Rate for Payer: UHCCP Medicaid |
$175.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.45
|
|
|
RPR TDN/MUS F/A&/W SEC FR GRF
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
76100601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.68 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Ambetter Exchange |
$636.89
|
| Rate for Payer: Anthem Medicaid |
$452.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$636.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$636.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.27
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,397.45
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$452.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.73
|
| Rate for Payer: Molina Healthcare Passport |
$452.68
|
| Rate for Payer: Multiplan PHCS |
$834.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$827.96
|
| Rate for Payer: UHCCP Medicaid |
$486.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$636.89
|
|
|
RPR TDN/MUS F/A&/W SEC FR GRF
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
76100601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,070.30
|
| Rate for Payer: Anthem Medicaid |
$478.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,084.20
|
| 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 |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,153.70
|
| Rate for Payer: First Health Commercial |
$1,320.50
|
| Rate for Payer: Humana Commercial |
$1,181.50
|
| Rate for Payer: Humana KY Medicaid |
$478.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$482.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,139.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,025.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$487.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,223.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,209.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.10
|
| Rate for Payer: PHCS Commercial |
$1,334.40
|
| Rate for Payer: United Healthcare All Payer |
$1,223.20
|
|
|
RPR TDN/MUS F/A&/W SEC FR GRF
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
76100601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,334.40 |
| Rate for Payer: Aetna Commercial |
$1,070.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,084.20
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,153.70
|
| Rate for Payer: First Health Commercial |
$1,320.50
|
| Rate for Payer: Humana Commercial |
$1,181.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,139.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,025.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,223.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,042.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,209.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.10
|
| Rate for Payer: PHCS Commercial |
$1,334.40
|
| Rate for Payer: United Healthcare All Payer |
$1,223.20
|
|
|
RPR TDN/MUS F/A&/W SEC FR GR(P
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25274
|
| Hospital Charge Code |
761P0601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.68 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Ambetter Exchange |
$636.89
|
| Rate for Payer: Anthem Medicaid |
$452.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$636.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$636.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.27
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$1,397.45
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$452.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.73
|
| Rate for Payer: Molina Healthcare Passport |
$452.68
|
| Rate for Payer: Multiplan PHCS |
$834.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$827.96
|
| Rate for Payer: UHCCP Medicaid |
$486.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$457.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$636.89
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMU(P
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
761P0599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.05 |
| Max. Negotiated Rate |
$1,310.62 |
| Rate for Payer: Aetna Commercial |
$976.24
|
| Rate for Payer: Ambetter Exchange |
$606.59
|
| Rate for Payer: Anthem Medicaid |
$396.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$606.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$606.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$727.91
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,310.62
|
| Rate for Payer: Healthspan PPO |
$884.27
|
| Rate for Payer: Humana Medicaid |
$396.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$807.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$606.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.97
|
| Rate for Payer: Molina Healthcare Passport |
$396.05
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$788.57
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$606.59
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMUS
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
76100599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.83 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem Medicaid |
$460.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| 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 |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Humana KY Medicaid |
$460.83
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$470.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.60
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMUS
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
76100599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.00 |
| Max. Negotiated Rate |
$1,286.40 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.60
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
RPR TDNMUSFLXR ARMWRST TDNMUS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25263
|
| Hospital Charge Code |
76100599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.05 |
| Max. Negotiated Rate |
$1,310.62 |
| Rate for Payer: Aetna Commercial |
$976.24
|
| Rate for Payer: Ambetter Exchange |
$606.59
|
| Rate for Payer: Anthem Medicaid |
$396.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$606.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$606.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$727.91
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,310.62
|
| Rate for Payer: Healthspan PPO |
$884.27
|
| Rate for Payer: Humana Medicaid |
$396.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$807.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$606.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.97
|
| Rate for Payer: Molina Healthcare Passport |
$396.05
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$788.57
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$606.59
|
|
