|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76100600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$1,110.31 |
| Rate for Payer: Aetna Commercial |
$784.08
|
| Rate for Payer: Ambetter Exchange |
$473.78
|
| Rate for Payer: Anthem Medicaid |
$271.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$473.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$473.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$568.54
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,110.31
|
| Rate for Payer: Healthspan PPO |
$710.21
|
| Rate for Payer: Humana Medicaid |
$271.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$473.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.46
|
| Rate for Payer: Molina Healthcare Passport |
$271.04
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$615.91
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$473.78
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76100600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
761P0600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$1,110.31 |
| Rate for Payer: Aetna Commercial |
$784.08
|
| Rate for Payer: Ambetter Exchange |
$473.78
|
| Rate for Payer: Anthem Medicaid |
$271.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$473.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$473.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$568.54
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,110.31
|
| Rate for Payer: Healthspan PPO |
$710.21
|
| Rate for Payer: Humana Medicaid |
$271.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$473.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.46
|
| Rate for Payer: Molina Healthcare Passport |
$271.04
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$615.91
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$473.78
|
|
|
RPR TDNMUS XTNSR F/ARMWRI PRIM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76100600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.26 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RPR TENDON EXT FOOT 1/2
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
76100993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$565.21 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Ambetter Exchange |
$303.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.82
|
| Rate for Payer: Anthem Medicaid |
$202.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.68
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$507.24
|
| Rate for Payer: Healthspan PPO |
$565.21
|
| Rate for Payer: Humana Medicaid |
$202.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$380.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.84
|
| Rate for Payer: Molina Healthcare Passport |
$202.78
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.07
|
| Rate for Payer: UHCCP Medicaid |
$170.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.90
|
|
|
RPR TENDON EXT FOOT 1/2
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
76100993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| 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 |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
RPR TENDON EXT FOOT 1/2
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
76100993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
RPR TENDON EXT FOOT 1/2 (P
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 28208
|
| Hospital Charge Code |
761P0993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$565.21 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Ambetter Exchange |
$303.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.82
|
| Rate for Payer: Anthem Medicaid |
$202.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.68
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$507.24
|
| Rate for Payer: Healthspan PPO |
$565.21
|
| Rate for Payer: Humana Medicaid |
$202.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$380.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$206.84
|
| Rate for Payer: Molina Healthcare Passport |
$202.78
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.07
|
| Rate for Payer: UHCCP Medicaid |
$170.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$204.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.90
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
76100696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.29 |
| Max. Negotiated Rate |
$1,299.88 |
| Rate for Payer: Aetna Commercial |
$1,053.93
|
| Rate for Payer: Ambetter Exchange |
$737.77
|
| Rate for Payer: Anthem Medicaid |
$374.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$737.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$737.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$885.32
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,299.88
|
| Rate for Payer: Healthspan PPO |
$954.64
|
| Rate for Payer: Humana Medicaid |
$374.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$911.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$737.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$737.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.78
|
| Rate for Payer: Molina Healthcare Passport |
$374.29
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.10
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$378.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$737.77
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
76100696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
76100696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
RPR XTNSR TDN CNTRL WFR GRFT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26428
|
| Hospital Charge Code |
761P0696
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.29 |
| Max. Negotiated Rate |
$1,299.88 |
| Rate for Payer: Aetna Commercial |
$1,053.93
|
| Rate for Payer: Ambetter Exchange |
$737.77
|
| Rate for Payer: Anthem Medicaid |
$374.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$737.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$737.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$885.32
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,299.88
|
| Rate for Payer: Healthspan PPO |
$954.64
|
| Rate for Payer: Humana Medicaid |
$374.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$911.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$737.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$737.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.78
|
| Rate for Payer: Molina Healthcare Passport |
$374.29
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.10
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$378.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$737.77
|
|
|
RRAD 5F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
RRAD 5F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
RR PHYSICAL
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.68
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
RR PHYSICAL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
RR PHYSICAL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
RR PHYSICAL(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
510P0114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.68
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
RSP GLENOD HD W/RET SCRW-4M 32
|
Facility
|
IP
|
$7,204.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.44 |
| Max. Negotiated Rate |
$6,916.61 |
| Rate for Payer: Aetna Commercial |
$5,547.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.74
|
| Rate for Payer: Cash Price |
$3,602.40
|
| Rate for Payer: Cigna Commercial |
$5,979.98
|
| Rate for Payer: First Health Commercial |
$6,844.56
|
| Rate for Payer: Humana Commercial |
$6,124.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,907.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,763.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.31
|
| Rate for Payer: PHCS Commercial |
$6,916.61
|
| Rate for Payer: United Healthcare All Payer |
$6,340.22
|
|
|
RSP GLENOD HD W/RET SCRW-4M 32
|
Facility
|
OP
|
$7,204.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.44 |
| Max. Negotiated Rate |
$6,916.61 |
| Rate for Payer: Aetna Commercial |
$5,547.70
|
| Rate for Payer: Anthem Medicaid |
$2,477.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.74
|
| Rate for Payer: Cash Price |
$3,602.40
|
| Rate for Payer: Cigna Commercial |
$5,979.98
|
| Rate for Payer: First Health Commercial |
$6,844.56
|
| Rate for Payer: Humana Commercial |
$6,124.08
|
| Rate for Payer: Humana KY Medicaid |
$2,477.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,502.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,907.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,763.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.31
|
| Rate for Payer: PHCS Commercial |
$6,916.61
|
| Rate for Payer: United Healthcare All Payer |
$6,340.22
|
|
|
RSP GLENOID BASEPLATE 30MM
|
Facility
|
OP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem Medicaid |
$2,861.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Humana KY Medicaid |
$2,861.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
RSP GLENOID BASEPLATE 30MM
|
Facility
|
IP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
RSP GLENOID HD W/RET SCRW NEU
|
Facility
|
IP
|
$8,260.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,478.00 |
| Max. Negotiated Rate |
$7,929.61 |
| Rate for Payer: Aetna Commercial |
$6,360.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,442.81
|
| Rate for Payer: Cash Price |
$4,130.01
|
| Rate for Payer: Cigna Commercial |
$6,855.81
|
| Rate for Payer: First Health Commercial |
$7,847.01
|
| Rate for Payer: Humana Commercial |
$7,021.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,773.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,095.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,268.81
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,608.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,186.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,699.41
|
| Rate for Payer: PHCS Commercial |
$7,929.61
|
| Rate for Payer: United Healthcare All Payer |
$7,268.81
|
|
|
RSP GLENOID HD W/RET SCRW NEU
|
Facility
|
OP
|
$8,260.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,478.00 |
| Max. Negotiated Rate |
$7,929.61 |
| Rate for Payer: Aetna Commercial |
$6,360.21
|
| Rate for Payer: Anthem Medicaid |
$2,840.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,442.81
|
| Rate for Payer: Cash Price |
$4,130.01
|
| Rate for Payer: Cigna Commercial |
$6,855.81
|
| Rate for Payer: First Health Commercial |
$7,847.01
|
| Rate for Payer: Humana Commercial |
$7,021.01
|
| Rate for Payer: Humana KY Medicaid |
$2,840.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,869.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,773.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,095.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,897.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,268.81
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,608.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,186.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,699.41
|
| Rate for Payer: PHCS Commercial |
$7,929.61
|
| Rate for Payer: United Healthcare All Payer |
$7,268.81
|
|
|
RSP HUMERAL SOCKT INSRT 36MM+4
|
Facility
|
OP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem Medicaid |
$1,802.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Humana KY Medicaid |
$1,802.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
