|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320T0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,675.48 |
| Max. Negotiated Rate |
$4,677.12 |
| Rate for Payer: Aetna Commercial |
$3,751.44
|
| Rate for Payer: Anthem Medicaid |
$1,675.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,800.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$4,043.76
|
| Rate for Payer: First Health Commercial |
$4,628.40
|
| Rate for Payer: Humana Commercial |
$4,141.20
|
| Rate for Payer: Humana KY Medicaid |
$1,675.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,692.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,995.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,595.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,709.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,287.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,238.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,361.68
|
| Rate for Payer: PHCS Commercial |
$4,677.12
|
| Rate for Payer: United Healthcare All Payer |
$4,287.36
|
|
|
Abd LsrHairRem-PP #1 50%
|
Professional
|
Both
|
$192.00
|
|
| Hospital Charge Code |
22200322
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
|
|
Abd LsrHairRem-PP #2/3 25%
|
Professional
|
Both
|
$95.00
|
|
| Hospital Charge Code |
22200526
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
|
|
ABDOMEN 3 OR MORE VIEWS
|
Facility
|
OP
|
$588.00
|
|
| Hospital Charge Code |
32000992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem Medicaid |
$202.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Humana KY Medicaid |
$202.21
|
| Rate for Payer: Kentucky WC Medicaid |
$204.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$405.72
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
ABDOMEN 3 OR MORE VIEWS
|
Facility
|
IP
|
$588.00
|
|
| Hospital Charge Code |
32000992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$405.72
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
ABDOMEN 3 OR MORE VIEWS
|
Professional
|
Both
|
$588.00
|
|
| Hospital Charge Code |
32000992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Multiplan PHCS |
$352.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$411.60
|
| Rate for Payer: UHCCP Medicaid |
$205.80
|
|
|
ABDOMEN 3 OR MORE VIEWS(P
|
Professional
|
Both
|
$215.00
|
|
| Hospital Charge Code |
320P0992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
|
|
ABDOMEN 3 OR MORE VIEWS(T
|
Facility
|
IP
|
$373.00
|
|
| Hospital Charge Code |
320T0992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$358.08 |
| Rate for Payer: Aetna Commercial |
$287.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.94
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$309.59
|
| Rate for Payer: First Health Commercial |
$354.35
|
| Rate for Payer: Humana Commercial |
$317.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$275.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$328.24
|
| Rate for Payer: Ohio Health Group HMO |
$279.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$324.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.37
|
| Rate for Payer: PHCS Commercial |
$358.08
|
| Rate for Payer: United Healthcare All Payer |
$328.24
|
|
|
ABDOMEN 3 OR MORE VIEWS(T
|
Facility
|
OP
|
$373.00
|
|
| Hospital Charge Code |
320T0992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$358.08 |
| Rate for Payer: Aetna Commercial |
$287.21
|
| Rate for Payer: Anthem Medicaid |
$128.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.94
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$309.59
|
| Rate for Payer: First Health Commercial |
$354.35
|
| Rate for Payer: Humana Commercial |
$317.05
|
| Rate for Payer: Humana KY Medicaid |
$128.27
|
| Rate for Payer: Kentucky WC Medicaid |
$129.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$275.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$328.24
|
| Rate for Payer: Ohio Health Group HMO |
$279.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$324.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.37
|
| Rate for Payer: PHCS Commercial |
$358.08
|
| Rate for Payer: United Healthcare All Payer |
$328.24
|
|
|
Abdomen Laser Hair Removal
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200321
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$105.00 |
| 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
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$244.09
|
| Rate for Payer: Anthem Medicaid |
$109.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$263.11
|
| Rate for Payer: First Health Commercial |
$301.15
|
| Rate for Payer: Humana Commercial |
$269.45
|
| Rate for Payer: Humana KY Medicaid |
$109.02
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$110.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.96
|
| Rate for Payer: Ohio Health Group HMO |
$237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.73
|
| Rate for Payer: PHCS Commercial |
$304.32
|
| Rate for Payer: United Healthcare All Payer |
$278.96
|
|
|
ABDOMEN - UPRIGHT AP
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.10 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$244.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.26
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$263.11
|
| Rate for Payer: First Health Commercial |
$301.15
|
| Rate for Payer: Humana Commercial |
$269.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.96
|
| Rate for Payer: Ohio Health Group HMO |
$237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.73
|
| Rate for Payer: PHCS Commercial |
$304.32
|
| Rate for Payer: United Healthcare All Payer |
$278.96
|
|
|
ABDOMEN - UPRIGHT AP
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$190.20 |
| Rate for Payer: Ambetter Exchange |
$27.12
|
| Rate for Payer: Anthem Medicaid |
$20.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.54
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| 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 |
$27.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.98
|
| Rate for Payer: Molina Healthcare Passport |
$20.57
|
| Rate for Payer: Multiplan PHCS |
$190.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.26
|
| Rate for Payer: UHCCP Medicaid |
$110.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.12
|
|
|
ABDOMEN - UPRIGHT AP(P
|
Professional
|
Both
|
$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: Ambetter Exchange |
$27.12
|
| Rate for Payer: Anthem Medicaid |
$20.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.54
|
| 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 |
$27.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.12
|
| 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 |
$35.26
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.12
|
|
|
ABDOMEN - UPRIGHT AP(T
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
320T0117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
ABDOMEN - UPRIGHT AP(T
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
320T0117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem Medicaid |
$95.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Humana KY Medicaid |
$95.26
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$96.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
ABDOMEN W CONTRAST
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
35000060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,699.52 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem Medicaid |
$967.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,193.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Humana KY Medicaid |
$967.05
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$976.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$986.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
ABDOMEN W CONTRAST
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
35000060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$843.60 |
| Max. Negotiated Rate |
$2,699.52 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,193.36
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
ABDOMEN W CONTRAST
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
35000060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Aetna Commercial |
$552.25
|
| Rate for Payer: Ambetter Exchange |
$210.83
|
| Rate for Payer: Anthem Medicaid |
$239.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$210.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| 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 |
$210.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.10
|
| Rate for Payer: Molina Healthcare Passport |
$239.31
|
| Rate for Payer: Multiplan PHCS |
$1,687.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$274.08
|
| Rate for Payer: UHCCP Medicaid |
$984.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.83
|
|
|
ABDOMEN W CONTRAST(P
|
Professional
|
Both
|
$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: Ambetter Exchange |
$210.83
|
| Rate for Payer: Anthem Medicaid |
$239.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$210.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.00
|
| 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 |
$210.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.83
|
| 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 |
$274.08
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.83
|
|
|
ABDOMEN W CONTRAST(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
350T0060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$776.10 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
ABDOMEN W CONTRAST(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 74160
|
| Hospital Charge Code |
350T0060
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem Medicaid |
$889.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Humana KY Medicaid |
$889.67
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$898.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$907.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
35000059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,507.52 |
| Rate for Payer: Aetna Commercial |
$2,011.24
|
| Rate for Payer: Anthem Medicaid |
$898.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,037.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cigna Commercial |
$2,167.96
|
| Rate for Payer: First Health Commercial |
$2,481.40
|
| Rate for Payer: Humana Commercial |
$2,220.20
|
| Rate for Payer: Humana KY Medicaid |
$898.27
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$907.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,141.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,927.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$916.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,298.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,959.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,272.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,802.28
|
| Rate for Payer: PHCS Commercial |
$2,507.52
|
| Rate for Payer: United Healthcare All Payer |
$2,298.56
|
|
|
ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
35000059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$783.60 |
| Max. Negotiated Rate |
$2,507.52 |
| Rate for Payer: Aetna Commercial |
$2,011.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,037.36
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cigna Commercial |
$2,167.96
|
| Rate for Payer: First Health Commercial |
$2,481.40
|
| Rate for Payer: Humana Commercial |
$2,220.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,141.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,927.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$783.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,298.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,959.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,272.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,802.28
|
| Rate for Payer: PHCS Commercial |
$2,507.52
|
| Rate for Payer: United Healthcare All Payer |
$2,298.56
|
|
|
ABDOMEN W/O CONTRAST
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
35000059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$1,567.20 |
| Rate for Payer: Aetna Commercial |
$389.05
|
| Rate for Payer: Ambetter Exchange |
$125.95
|
| Rate for Payer: Anthem Medicaid |
$203.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$151.14
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cash Price |
$1,306.00
|
| 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 |
$125.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.96
|
| Rate for Payer: Molina Healthcare Passport |
$203.88
|
| Rate for Payer: Multiplan PHCS |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.74
|
| Rate for Payer: UHCCP Medicaid |
$914.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.95
|
|
