|
ABDOMEN W/O CONTRAST(P
|
Professional
|
Both
|
$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: 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 |
$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 |
$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 |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$163.74
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.95
|
|
|
ABDOMEN W/O CONTRAST(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
350T0059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$716.10 |
| Max. Negotiated Rate |
$2,291.52 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna Commercial |
$1,981.21
|
| Rate for Payer: First Health Commercial |
$2,267.65
|
| Rate for Payer: Humana Commercial |
$2,028.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,957.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,761.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$716.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,100.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,790.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.03
|
| Rate for Payer: PHCS Commercial |
$2,291.52
|
| Rate for Payer: United Healthcare All Payer |
$2,100.56
|
|
|
ABDOMEN W/O CONTRAST(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 74150
|
| Hospital Charge Code |
350T0059
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,291.52 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Anthem Medicaid |
$820.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna Commercial |
$1,981.21
|
| Rate for Payer: First Health Commercial |
$2,267.65
|
| Rate for Payer: Humana Commercial |
$2,028.95
|
| Rate for Payer: Humana KY Medicaid |
$820.89
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$829.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,957.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,761.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$837.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,100.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,790.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.03
|
| Rate for Payer: PHCS Commercial |
$2,291.52
|
| Rate for Payer: United Healthcare All Payer |
$2,100.56
|
|
|
ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
35000061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,915.52 |
| Rate for Payer: Aetna Commercial |
$2,338.49
|
| Rate for Payer: Anthem Medicaid |
$1,044.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$2,520.71
|
| Rate for Payer: First Health Commercial |
$2,885.15
|
| Rate for Payer: Humana Commercial |
$2,581.45
|
| Rate for Payer: Humana KY Medicaid |
$1,044.42
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,672.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.53
|
| Rate for Payer: PHCS Commercial |
$2,915.52
|
| Rate for Payer: United Healthcare All Payer |
$2,672.56
|
|
|
ABDOMEN W/WO CONTRAST
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
35000061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.14 |
| Max. Negotiated Rate |
$1,822.20 |
| Rate for Payer: Aetna Commercial |
$625.04
|
| Rate for Payer: Ambetter Exchange |
$236.85
|
| Rate for Payer: Anthem Medicaid |
$289.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.22
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| 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 |
$236.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$295.07
|
| Rate for Payer: Molina Healthcare Passport |
$289.28
|
| Rate for Payer: Multiplan PHCS |
$1,822.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.90
|
| Rate for Payer: UHCCP Medicaid |
$1,062.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.85
|
|
|
ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
35000061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$911.10 |
| Max. Negotiated Rate |
$2,915.52 |
| Rate for Payer: Aetna Commercial |
$2,338.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.86
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$2,520.71
|
| Rate for Payer: First Health Commercial |
$2,885.15
|
| Rate for Payer: Humana Commercial |
$2,581.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,672.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.53
|
| Rate for Payer: PHCS Commercial |
$2,915.52
|
| Rate for Payer: United Healthcare All Payer |
$2,672.56
|
|
|
ABDOMEN W/WO CONTRAST(P
|
Professional
|
Both
|
$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: Ambetter Exchange |
$236.85
|
| Rate for Payer: Anthem Medicaid |
$289.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.22
|
| 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 |
$236.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.85
|
| 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 |
$307.90
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.85
|
|
|
ABDOMEN W/WO CONTRAST(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
350T0061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$836.10 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$836.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
ABDOMEN W/WO CONTRAST(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 74170
|
| Hospital Charge Code |
350T0061
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem Medicaid |
$958.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Humana KY Medicaid |
$958.45
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$968.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$977.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
ABDOMINAL AORTAGRAM
|
Facility
|
OP
|
$5,272.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
32000153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,813.04 |
| Max. Negotiated Rate |
$5,061.12 |
| Rate for Payer: Aetna Commercial |
$4,059.44
|
| Rate for Payer: Anthem Medicaid |
$1,813.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,112.16
|
| 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 |
$2,636.00
|
| Rate for Payer: Cash Price |
$2,636.00
|
| Rate for Payer: Cigna Commercial |
$4,375.76
|
| Rate for Payer: First Health Commercial |
$5,008.40
|
| Rate for Payer: Humana Commercial |
$4,481.20
|
| Rate for Payer: Humana KY Medicaid |
$1,813.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,831.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,323.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,890.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,849.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,639.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,954.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,586.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.68
|
| Rate for Payer: PHCS Commercial |
$5,061.12
|
| Rate for Payer: United Healthcare All Payer |
$4,639.36
|
|
|
ABDOMINAL AORTAGRAM
|
Professional
|
Both
|
$5,272.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
32000153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$3,163.20 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Ambetter Exchange |
$115.81
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.97
|
| Rate for Payer: Cash Price |
$2,636.00
|
| Rate for Payer: Cash Price |
$2,636.00
|
| 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 |
$115.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,163.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.55
|
| Rate for Payer: UHCCP Medicaid |
$1,845.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.81
|
|
|
ABDOMINAL AORTAGRAM
|
Facility
|
IP
|
$5,272.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
32000153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,581.60 |
| Max. Negotiated Rate |
$5,061.12 |
| Rate for Payer: Aetna Commercial |
$4,059.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,112.16
|
| Rate for Payer: Cash Price |
$2,636.00
|
| Rate for Payer: Cigna Commercial |
$4,375.76
|
| Rate for Payer: First Health Commercial |
$5,008.40
|
| Rate for Payer: Humana Commercial |
$4,481.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,323.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,890.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,639.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,954.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,586.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.68
|
| Rate for Payer: PHCS Commercial |
$5,061.12
|
| Rate for Payer: United Healthcare All Payer |
$4,639.36
|
|
|
ABDOMINAL AORTAGRAM(P
|
Professional
|
Both
|
$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: Ambetter Exchange |
$115.81
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.97
|
| 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 |
$115.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.81
|
| 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 |
$150.55
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.81
|
|
|
ABDOMINAL AORTAGRAM(T
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
320T0153
|
|
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
|
|
|
ABDOMINAL AORTAGRAM(T
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
320T0153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$4,677.12 |
| Rate for Payer: Aetna Commercial |
$3,751.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,800.16
|
| 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: 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 |
$1,461.60
|
| 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
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
45000274
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$675.30 |
| Max. Negotiated Rate |
$2,160.96 |
| Rate for Payer: Aetna Commercial |
$1,733.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.78
|
| Rate for Payer: Cash Price |
$1,125.50
|
| Rate for Payer: Cigna Commercial |
$1,868.33
|
| Rate for Payer: First Health Commercial |
$2,138.45
|
| Rate for Payer: Humana Commercial |
$1,913.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,661.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,688.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,958.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.19
|
| Rate for Payer: PHCS Commercial |
$2,160.96
|
| Rate for Payer: United Healthcare All Payer |
$1,980.88
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
32001003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem Medicaid |
$980.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Humana KY Medicaid |
$980.46
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$990.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,000.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76101980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$1,710.60 |
| Rate for Payer: Ambetter Exchange |
$99.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$240.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.24
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$240.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$245.01
|
| Rate for Payer: Molina Healthcare Passport |
$240.21
|
| Rate for Payer: Multiplan PHCS |
$1,710.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.18
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.37
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
32001003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$855.30 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
45000274
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$774.12 |
| Max. Negotiated Rate |
$2,160.96 |
| Rate for Payer: Aetna Commercial |
$1,733.27
|
| Rate for Payer: Anthem Medicaid |
$774.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,125.50
|
| Rate for Payer: Cash Price |
$1,125.50
|
| Rate for Payer: Cigna Commercial |
$1,868.33
|
| Rate for Payer: First Health Commercial |
$2,138.45
|
| Rate for Payer: Humana Commercial |
$1,913.35
|
| Rate for Payer: Humana KY Medicaid |
$774.12
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$782.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,661.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,688.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,958.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.19
|
| Rate for Payer: PHCS Commercial |
$2,160.96
|
| Rate for Payer: United Healthcare All Payer |
$1,980.88
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76101980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.30 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76101980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem Medicaid |
$980.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Humana KY Medicaid |
$980.46
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$990.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,000.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
ABDOMINAL PARACENTESIS W/IMG
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
32001003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$1,710.60 |
| Rate for Payer: Ambetter Exchange |
$99.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$240.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.24
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$240.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$245.01
|
| Rate for Payer: Molina Healthcare Passport |
$240.21
|
| Rate for Payer: Multiplan PHCS |
$1,710.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.18
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.37
|
|
|
ABDOMINAL PARACENTESIS W/IMG(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761P1980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Ambetter Exchange |
$99.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$240.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.24
|
| 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 |
$240.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$245.01
|
| Rate for Payer: Molina Healthcare Passport |
$240.21
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.18
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.37
|
|
|
ABDOMINAL PARACENTESIS W/IMG(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
320P1003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Ambetter Exchange |
$99.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$240.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.24
|
| 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 |
$240.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$245.01
|
| Rate for Payer: Molina Healthcare Passport |
$240.21
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.18
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.37
|
|
