|
ABDOMINAL AORTAGRAM
|
Professional
|
$4,975.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
32000153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$4,975.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,975.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.57
|
| Rate for Payer: Cash Price |
$2,487.50
|
| Rate for Payer: Cash Price |
$2,487.50
|
| Rate for Payer: Cigna Commercial |
$682.81
|
| Rate for Payer: Healthspan PPO |
$396.36
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,985.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.78
|
| Rate for Payer: UHCCP Medicaid |
$1,741.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.14
|
|
|
ABDOMINAL AORTAGRAM
|
Facility
IP
|
$4,975.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
32000153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$646.75 |
| Max. Negotiated Rate |
$4,776.00 |
| Rate for Payer: Aetna Commercial |
$3,830.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,880.50
|
| Rate for Payer: Cash Price |
$2,487.50
|
| Rate for Payer: Cigna Commercial |
$4,129.25
|
| Rate for Payer: First Health Commercial |
$4,726.25
|
| Rate for Payer: Humana Commercial |
$4,228.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,079.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,671.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,492.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,378.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$646.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.25
|
| Rate for Payer: PHCS Commercial |
$4,776.00
|
|
|
ABDOMINAL AORTAGRAM
|
Facility
OP
|
$4,975.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
32000153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$646.75 |
| Max. Negotiated Rate |
$4,776.00 |
| Rate for Payer: Aetna Commercial |
$3,830.75
|
| Rate for Payer: Anthem Medicaid |
$1,710.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,880.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,487.50
|
| Rate for Payer: Cash Price |
$2,487.50
|
| Rate for Payer: Cigna Commercial |
$4,129.25
|
| Rate for Payer: First Health Commercial |
$4,726.25
|
| Rate for Payer: Humana Commercial |
$4,228.75
|
| Rate for Payer: Humana KY Medicaid |
$1,710.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,728.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,079.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,671.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,745.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,378.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$646.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.25
|
| Rate for Payer: PHCS Commercial |
$4,776.00
|
| Rate for Payer: United Healthcare All Payer |
$4,378.00
|
|
|
ABDOMINAL AORTAGRAM(P
|
Professional
|
$400.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
320P0153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$682.81 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.57
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$682.81
|
| Rate for Payer: Healthspan PPO |
$396.36
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.78
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.14
|
|
|
ABDOMINAL AORTAGRAM(T
|
Facility
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
320T0153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
|
|
ABDOMINAL AORTAGRAM(T
|
Facility
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
320T0153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem Medicaid |
$1,573.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Humana KY Medicaid |
$1,573.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Professional
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76101980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$2,714.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$86.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,714.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.03
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$86.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.70
|
| Rate for Payer: Molina Healthcare Passport |
$86.96
|
| Rate for Payer: Multiplan PHCS |
$1,628.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.37
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.36
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76101980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.82 |
| Max. Negotiated Rate |
$2,605.44 |
| Rate for Payer: Aetna Commercial |
$2,089.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.92
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$2,252.62
|
| Rate for Payer: First Health Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial |
$2,306.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,225.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$814.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,388.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,035.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.34
|
| Rate for Payer: PHCS Commercial |
$2,605.44
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76101980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.82 |
| Max. Negotiated Rate |
$2,605.44 |
| Rate for Payer: Aetna Commercial |
$2,089.78
|
| Rate for Payer: Anthem Medicaid |
$933.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$2,252.62
|
| Rate for Payer: First Health Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial |
$2,306.90
|
| Rate for Payer: Humana KY Medicaid |
$933.34
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$942.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,225.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$952.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,388.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,035.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.34
|
| Rate for Payer: PHCS Commercial |
$2,605.44
|
| Rate for Payer: United Healthcare All Payer |
$2,388.32
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
32001003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.82 |
| Max. Negotiated Rate |
$2,605.44 |
| Rate for Payer: Aetna Commercial |
$2,089.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.92
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$2,252.62
|
| Rate for Payer: First Health Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial |
$2,306.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,225.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$814.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,388.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,035.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.34
|
| Rate for Payer: PHCS Commercial |
$2,605.44
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
32001003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.82 |
| Max. Negotiated Rate |
$2,605.44 |
| Rate for Payer: Aetna Commercial |
$2,089.78
|
| Rate for Payer: Anthem Medicaid |
$933.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$2,252.62
|
| Rate for Payer: First Health Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial |
$2,306.90
|
| Rate for Payer: Humana KY Medicaid |
$933.34
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$942.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,225.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$952.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,388.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,035.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.34
|
| Rate for Payer: PHCS Commercial |
$2,605.44
|
| Rate for Payer: United Healthcare All Payer |
$2,388.32
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
IP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
45000274
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Professional
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
32001003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$2,714.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$86.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,714.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.03
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$86.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.70
|
| Rate for Payer: Molina Healthcare Passport |
$86.96
|
| Rate for Payer: Multiplan PHCS |
$1,628.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.37
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.36
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
OP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
45000274
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem Medicaid |
$727.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Humana KY Medicaid |
$727.00
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$734.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
| Rate for Payer: United Healthcare All Payer |
$1,860.32
|
|
|
ABDOMINAL PARACENTESIS W/IMG(P
|
Professional
|
$600.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761P1980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$86.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.03
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$86.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.70
|
| Rate for Payer: Molina Healthcare Passport |
$86.96
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.37
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.36
|
|
|
ABDOMINAL PARACENTESIS W/IMG(P
|
Professional
|
$600.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
320P1003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$86.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.03
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$86.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.70
|
| Rate for Payer: Molina Healthcare Passport |
$86.96
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.37
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.36
|
|
|
ABDOMINAL PARACENTESIS W/IMG(T
|
Facility
OP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T1980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem Medicaid |
$727.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Humana KY Medicaid |
$727.00
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$734.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
| Rate for Payer: United Healthcare All Payer |
$1,860.32
|
|
|
ABDOMINAL PARACENTESIS W/IMG(T
|
Facility
IP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T1980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
|
|
ABDOMINAL PARACENTESIS W/IMG(T
|
Facility
OP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
320T1003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem Medicaid |
$727.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Humana KY Medicaid |
$727.00
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$734.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
| Rate for Payer: United Healthcare All Payer |
$1,860.32
|
|
|
ABDOMINAL PARACENTESIS W/IMG(T
|
Facility
IP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
320T1003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
76101979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$1,520.64 |
| Rate for Payer: Aetna Commercial |
$1,219.68
|
| Rate for Payer: Anthem Medicaid |
$544.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,235.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,314.72
|
| Rate for Payer: First Health Commercial |
$1,504.80
|
| Rate for Payer: Humana Commercial |
$1,346.40
|
| Rate for Payer: Humana KY Medicaid |
$544.74
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$550.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,298.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,168.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,393.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.04
|
| Rate for Payer: PHCS Commercial |
$1,520.64
|
| Rate for Payer: United Healthcare All Payer |
$1,393.92
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
76101979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$1,520.64 |
| Rate for Payer: Aetna Commercial |
$1,219.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,235.52
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,314.72
|
| Rate for Payer: First Health Commercial |
$1,504.80
|
| Rate for Payer: Humana Commercial |
$1,346.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,298.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,168.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$475.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,393.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.04
|
| Rate for Payer: PHCS Commercial |
$1,520.64
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
IP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
761T1979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.94
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Professional
|
$410.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
761P1979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.44
|
| Rate for Payer: Anthem Medicaid |
$56.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.72
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$271.02
|
| Rate for Payer: Healthspan PPO |
$152.59
|
| Rate for Payer: Humana Medicaid |
$56.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.40
|
| Rate for Payer: Molina Healthcare Passport |
$56.27
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.86
|
| Rate for Payer: UHCCP Medicaid |
$51.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.43
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
761T1979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem Medicaid |
$403.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Humana KY Medicaid |
$403.74
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.94
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
