|
Abdomen Laser Hair Removal
|
Professional
|
$150.00
|
|
| Hospital Charge Code |
22200321
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
ABDOMEN - UPRIGHT AP
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
|
|
ABDOMEN - UPRIGHT AP
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
ABDOMEN - UPRIGHT AP
|
Professional
|
$300.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem Medicaid |
$20.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.14
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$43.07
|
| Rate for Payer: Humana Medicaid |
$20.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.98
|
| Rate for Payer: Molina Healthcare Passport |
$20.57
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.98
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.45
|
|
|
ABDOMEN - UPRIGHT AP(P
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
320P0117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Anthem Medicaid |
$20.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.14
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$43.07
|
| Rate for Payer: Humana Medicaid |
$20.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.98
|
| Rate for Payer: Molina Healthcare Passport |
$20.57
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.98
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.45
|
|
|
ABDOMEN - UPRIGHT AP(T
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
320T0117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$89.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$89.41
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$90.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
ABDOMEN - UPRIGHT AP(T
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
320T0117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
|
|
ABDOMEN W CONTRAST
|
Facility
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
35000060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,547.84 |
| Rate for Payer: Aetna Commercial |
$2,043.58
|
| Rate for Payer: Anthem Medicaid |
$912.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,070.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$2,202.82
|
| Rate for Payer: First Health Commercial |
$2,521.30
|
| Rate for Payer: Humana Commercial |
$2,255.90
|
| Rate for Payer: Humana KY Medicaid |
$912.71
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$922.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,176.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,958.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$931.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,335.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,990.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.74
|
| Rate for Payer: PHCS Commercial |
$2,547.84
|
| Rate for Payer: United Healthcare All Payer |
$2,335.52
|
|
|
ABDOMEN W CONTRAST
|
Facility
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
35000060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$2,547.84 |
| Rate for Payer: Aetna Commercial |
$2,043.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,070.12
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$2,202.82
|
| Rate for Payer: First Health Commercial |
$2,521.30
|
| Rate for Payer: Humana Commercial |
$2,255.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,176.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,958.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,335.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,990.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.74
|
| Rate for Payer: PHCS Commercial |
$2,547.84
|
|
|
ABDOMEN W CONTRAST
|
Professional
|
$2,654.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
35000060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Aetna Commercial |
$552.25
|
| Rate for Payer: Anthem Medicaid |
$239.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$230.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,654.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$276.56
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$506.35
|
| Rate for Payer: Healthspan PPO |
$379.48
|
| Rate for Payer: Humana Medicaid |
$239.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$230.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.10
|
| Rate for Payer: Molina Healthcare Passport |
$239.31
|
| Rate for Payer: Multiplan PHCS |
$1,592.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$299.61
|
| Rate for Payer: UHCCP Medicaid |
$928.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$230.47
|
|
|
ABDOMEN W CONTRAST(P
|
Professional
|
$225.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
350P0060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$552.25 |
| Rate for Payer: Aetna Commercial |
$552.25
|
| Rate for Payer: Anthem Medicaid |
$239.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$230.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$276.56
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$506.35
|
| Rate for Payer: Healthspan PPO |
$379.48
|
| Rate for Payer: Humana Medicaid |
$239.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$230.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.10
|
| Rate for Payer: Molina Healthcare Passport |
$239.31
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$299.61
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$230.47
|
|
|
ABDOMEN W CONTRAST(T
|
Facility
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
350T0060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
|
|
ABDOMEN W CONTRAST(T
|
Facility
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
350T0060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem Medicaid |
$835.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Humana KY Medicaid |
$835.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
ABDOMEN W/O CONTRAST
|
Facility
OP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
35000059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,368.32 |
| Rate for Payer: Aetna Commercial |
$1,899.59
|
| Rate for Payer: Anthem Medicaid |
$848.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,924.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cigna Commercial |
$2,047.61
|
| Rate for Payer: First Health Commercial |
$2,343.65
|
| Rate for Payer: Humana Commercial |
$2,096.95
|
| Rate for Payer: Humana KY Medicaid |
$848.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$857.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,022.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,820.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,170.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,850.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.77
|
| Rate for Payer: PHCS Commercial |
$2,368.32
|
| Rate for Payer: United Healthcare All Payer |
$2,170.96
|
|
|
ABDOMEN W/O CONTRAST
|
Professional
|
$2,467.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
35000059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$2,467.00 |
| Rate for Payer: Aetna Commercial |
$389.05
|
| Rate for Payer: Anthem Medicaid |
$203.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$134.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,467.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.93
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cigna Commercial |
$412.21
|
| Rate for Payer: Healthspan PPO |
$267.33
|
| Rate for Payer: Humana Medicaid |
$203.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$134.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.96
|
| Rate for Payer: Molina Healthcare Passport |
$203.88
|
| Rate for Payer: Multiplan PHCS |
$1,480.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.42
|
| Rate for Payer: UHCCP Medicaid |
$863.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$134.94
|
|
|
ABDOMEN W/O CONTRAST
|
Facility
IP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
35000059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$320.71 |
| Max. Negotiated Rate |
$2,368.32 |
| Rate for Payer: Aetna Commercial |
$1,899.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,924.26
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cigna Commercial |
$2,047.61
|
| Rate for Payer: First Health Commercial |
$2,343.65
|
| Rate for Payer: Humana Commercial |
$2,096.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,022.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,820.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,170.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,850.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.77
|
| Rate for Payer: PHCS Commercial |
$2,368.32
|
|
|
ABDOMEN W/O CONTRAST(P
|
Professional
|
$225.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
350P0059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$412.21 |
| Rate for Payer: Aetna Commercial |
$389.05
|
| Rate for Payer: Anthem Medicaid |
$203.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$134.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.93
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$412.21
|
| Rate for Payer: Healthspan PPO |
$267.33
|
| Rate for Payer: Humana Medicaid |
$203.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$134.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.96
|
| Rate for Payer: Molina Healthcare Passport |
$203.88
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.42
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$134.94
|
|
|
ABDOMEN W/O CONTRAST(T
|
Facility
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
350T0059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,152.32 |
| Rate for Payer: Aetna Commercial |
$1,726.34
|
| Rate for Payer: Anthem Medicaid |
$771.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cigna Commercial |
$1,860.86
|
| Rate for Payer: First Health Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial |
$1,905.70
|
| Rate for Payer: Humana KY Medicaid |
$771.02
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$778.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,654.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,972.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.02
|
| Rate for Payer: PHCS Commercial |
$2,152.32
|
| Rate for Payer: United Healthcare All Payer |
$1,972.96
|
|
|
ABDOMEN W/O CONTRAST(T
|
Facility
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
350T0059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$291.46 |
| Max. Negotiated Rate |
$2,152.32 |
| Rate for Payer: Aetna Commercial |
$1,726.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cigna Commercial |
$1,860.86
|
| Rate for Payer: First Health Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial |
$1,905.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,654.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,972.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.02
|
| Rate for Payer: PHCS Commercial |
$2,152.32
|
|
|
ABDOMEN W/WO CONTRAST
|
Professional
|
$2,866.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
35000061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.14 |
| Max. Negotiated Rate |
$2,866.00 |
| Rate for Payer: Aetna Commercial |
$625.04
|
| Rate for Payer: Anthem Medicaid |
$289.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,866.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.04
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$631.55
|
| Rate for Payer: Healthspan PPO |
$429.50
|
| Rate for Payer: Humana Medicaid |
$289.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.07
|
| Rate for Payer: Molina Healthcare Passport |
$289.28
|
| Rate for Payer: Multiplan PHCS |
$1,719.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.88
|
| Rate for Payer: UHCCP Medicaid |
$1,003.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.37
|
|
|
ABDOMEN W/WO CONTRAST
|
Facility
IP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
35000061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$372.58 |
| Max. Negotiated Rate |
$2,751.36 |
| Rate for Payer: Aetna Commercial |
$2,206.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,235.48
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$2,378.78
|
| Rate for Payer: First Health Commercial |
$2,722.70
|
| Rate for Payer: Humana Commercial |
$2,436.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,350.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,115.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$859.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,522.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,149.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.46
|
| Rate for Payer: PHCS Commercial |
$2,751.36
|
|
|
ABDOMEN W/WO CONTRAST
|
Facility
OP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
35000061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,751.36 |
| Rate for Payer: Aetna Commercial |
$2,206.82
|
| Rate for Payer: Anthem Medicaid |
$985.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,235.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$2,378.78
|
| Rate for Payer: First Health Commercial |
$2,722.70
|
| Rate for Payer: Humana Commercial |
$2,436.10
|
| Rate for Payer: Humana KY Medicaid |
$985.62
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$995.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,350.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,115.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,005.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,522.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,149.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.46
|
| Rate for Payer: PHCS Commercial |
$2,751.36
|
| Rate for Payer: United Healthcare All Payer |
$2,522.08
|
|
|
ABDOMEN W/WO CONTRAST(P
|
Professional
|
$250.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
350P0061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$631.55 |
| Rate for Payer: Aetna Commercial |
$625.04
|
| Rate for Payer: Anthem Medicaid |
$289.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.04
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$631.55
|
| Rate for Payer: Healthspan PPO |
$429.50
|
| Rate for Payer: Humana Medicaid |
$289.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.07
|
| Rate for Payer: Molina Healthcare Passport |
$289.28
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.88
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.37
|
|
|
ABDOMEN W/WO CONTRAST(T
|
Facility
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
350T0061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,511.36 |
| Rate for Payer: Aetna Commercial |
$2,014.32
|
| Rate for Payer: Anthem Medicaid |
$899.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,040.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cigna Commercial |
$2,171.28
|
| Rate for Payer: First Health Commercial |
$2,485.20
|
| Rate for Payer: Humana Commercial |
$2,223.60
|
| Rate for Payer: Humana KY Medicaid |
$899.64
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$908.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,145.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,930.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$917.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,302.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,962.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.96
|
| Rate for Payer: PHCS Commercial |
$2,511.36
|
| Rate for Payer: United Healthcare All Payer |
$2,302.08
|
|
|
ABDOMEN W/WO CONTRAST(T
|
Facility
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
350T0061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$340.08 |
| Max. Negotiated Rate |
$2,511.36 |
| Rate for Payer: Aetna Commercial |
$2,014.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,040.48
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cigna Commercial |
$2,171.28
|
| Rate for Payer: First Health Commercial |
$2,485.20
|
| Rate for Payer: Humana Commercial |
$2,223.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,145.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,930.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$784.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,302.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,962.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.96
|
| Rate for Payer: PHCS Commercial |
$2,511.36
|
|
