|
ABDOMINAL PARACENTESIS W/IMG(T
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
320T1003
|
|
Hospital Revenue Code
|
320
|
| 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(T
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
320T1003
|
|
Hospital Revenue Code
|
320
|
| 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(T
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T1980
|
|
Hospital Revenue Code
|
761
|
| 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(T
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T1980
|
|
Hospital Revenue Code
|
761
|
| 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/O IMG
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
76101979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.50 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$1,251.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,267.50
|
| Rate for Payer: Cash Price |
$812.50
|
| Rate for Payer: Cigna Commercial |
$1,348.75
|
| Rate for Payer: First Health Commercial |
$1,543.75
|
| Rate for Payer: Humana Commercial |
$1,381.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,332.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,199.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$487.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,430.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,413.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.25
|
| Rate for Payer: PHCS Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Payer |
$1,430.00
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
76101979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.84 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$1,251.25
|
| Rate for Payer: Anthem Medicaid |
$558.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,267.50
|
| 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 |
$812.50
|
| Rate for Payer: Cash Price |
$812.50
|
| Rate for Payer: Cigna Commercial |
$1,348.75
|
| Rate for Payer: First Health Commercial |
$1,543.75
|
| Rate for Payer: Humana Commercial |
$1,381.25
|
| Rate for Payer: Humana KY Medicaid |
$558.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$564.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,332.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,199.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$570.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,430.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,413.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.25
|
| Rate for Payer: PHCS Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Payer |
$1,430.00
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
761P1979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$271.02 |
| Rate for Payer: Ambetter Exchange |
$68.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.44
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.22
|
| 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 |
$127.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.14
|
| Rate for Payer: Molina Healthcare Passport |
$127.59
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.08
|
| Rate for Payer: UHCCP Medicaid |
$51.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.52
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
76101979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Ambetter Exchange |
$68.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.44
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.22
|
| Rate for Payer: Cash Price |
$812.50
|
| Rate for Payer: Cash Price |
$812.50
|
| Rate for Payer: Cigna Commercial |
$271.02
|
| Rate for Payer: Healthspan PPO |
$152.59
|
| Rate for Payer: Humana Medicaid |
$127.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.14
|
| Rate for Payer: Molina Healthcare Passport |
$127.59
|
| Rate for Payer: Multiplan PHCS |
$975.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.08
|
| Rate for Payer: UHCCP Medicaid |
$51.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.52
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
761T1979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
761T1979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.84 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem Medicaid |
$417.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| 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 |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Humana KY Medicaid |
$417.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$422.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
ABDOMINOPLASTY
|
Facility
|
IP
|
$2,675.00
|
|
| Hospital Charge Code |
22200036
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$2,568.00 |
| Rate for Payer: Aetna Commercial |
$2,059.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,086.50
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Cigna Commercial |
$2,220.25
|
| Rate for Payer: First Health Commercial |
$2,541.25
|
| Rate for Payer: Humana Commercial |
$2,273.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,193.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,974.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,354.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,006.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,845.75
|
| Rate for Payer: PHCS Commercial |
$2,568.00
|
| Rate for Payer: United Healthcare All Payer |
$2,354.00
|
|
|
ABDOMINOPLASTY
|
Professional
|
Both
|
$2,675.00
|
|
| Hospital Charge Code |
22200036
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$1,872.50 |
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Multiplan PHCS |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,872.50
|
| Rate for Payer: UHCCP Medicaid |
$936.25
|
|
|
ABDOMINOPLASTY
|
Facility
|
OP
|
$2,675.00
|
|
| Hospital Charge Code |
22200036
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$802.50 |
| Max. Negotiated Rate |
$2,568.00 |
| Rate for Payer: Aetna Commercial |
$2,059.75
|
| Rate for Payer: Anthem Medicaid |
$919.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,086.50
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Cigna Commercial |
$2,220.25
|
| Rate for Payer: First Health Commercial |
$2,541.25
|
| Rate for Payer: Humana Commercial |
$2,273.75
|
| Rate for Payer: Humana KY Medicaid |
$919.93
|
| Rate for Payer: Kentucky WC Medicaid |
$929.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,193.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,974.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$938.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,354.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,006.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,845.75
|
| Rate for Payer: PHCS Commercial |
$2,568.00
|
| Rate for Payer: United Healthcare All Payer |
$2,354.00
|
|
|
ABDOMINOPLASTY -80
|
Facility
|
OP
|
$1,337.50
|
|
| Hospital Charge Code |
22200371
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$401.25 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$1,029.88
|
| Rate for Payer: Anthem Medicaid |
$459.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,043.25
|
| Rate for Payer: Cash Price |
$668.75
|
| Rate for Payer: Cigna Commercial |
$1,110.12
|
| Rate for Payer: First Health Commercial |
$1,270.62
|
| Rate for Payer: Humana Commercial |
$1,136.88
|
| Rate for Payer: Humana KY Medicaid |
$459.97
|
| Rate for Payer: Kentucky WC Medicaid |
$464.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,096.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$987.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$469.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,177.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,163.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$922.88
|
| Rate for Payer: PHCS Commercial |
$1,284.00
|
| Rate for Payer: United Healthcare All Payer |
$1,177.00
|
|
|
ABDOMINOPLASTY -80
|
Facility
|
IP
|
$1,337.50
|
|
| Hospital Charge Code |
22200371
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$401.25 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$1,029.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,043.25
|
| Rate for Payer: Cash Price |
$668.75
|
| Rate for Payer: Cigna Commercial |
$1,110.12
|
| Rate for Payer: First Health Commercial |
$1,270.62
|
| Rate for Payer: Humana Commercial |
$1,136.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,096.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$987.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,177.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,163.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$922.88
|
| Rate for Payer: PHCS Commercial |
$1,284.00
|
| Rate for Payer: United Healthcare All Payer |
$1,177.00
|
|
|
ABDOMINOPLASTY -80
|
Professional
|
Both
|
$1,337.50
|
|
| Hospital Charge Code |
22200371
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$468.12 |
| Max. Negotiated Rate |
$936.25 |
| Rate for Payer: Cash Price |
$668.75
|
| Rate for Payer: Multiplan PHCS |
$802.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$936.25
|
| Rate for Payer: UHCCP Medicaid |
$468.12
|
|
|
ABDOMINOPLASTY - MINI
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
22200085
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ABDOMINOPLASTY - MINI
|
Professional
|
Both
|
$780.00
|
|
| Hospital Charge Code |
22200085
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
|
|
ABDOMINOPLASTY - MINI
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
22200085
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ABDOMINOPLASTY-MINI -80
|
Facility
|
IP
|
$390.00
|
|
| Hospital Charge Code |
22200384
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.10
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
ABDOMINOPLASTY-MINI -80
|
Facility
|
OP
|
$390.00
|
|
| Hospital Charge Code |
22200384
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem Medicaid |
$134.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Humana KY Medicaid |
$134.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.10
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
ABDOMINOPLASTY-MINI -80
|
Professional
|
Both
|
$390.00
|
|
| Hospital Charge Code |
22200384
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
|
|
ABD ULTRASOUND COMPLETE
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$422.40 |
| Max. Negotiated Rate |
$1,351.68 |
| Rate for Payer: Aetna Commercial |
$1,084.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,098.24
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cigna Commercial |
$1,168.64
|
| Rate for Payer: First Health Commercial |
$1,337.60
|
| Rate for Payer: Humana Commercial |
$1,196.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,154.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,039.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$422.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,239.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$971.52
|
| Rate for Payer: PHCS Commercial |
$1,351.68
|
| Rate for Payer: United Healthcare All Payer |
$1,239.04
|
|
|
ABD ULTRASOUND COMPLETE
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$207.83
|
| Rate for Payer: Ambetter Exchange |
$104.53
|
| Rate for Payer: Anthem Medicaid |
$88.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.44
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cigna Commercial |
$183.40
|
| Rate for Payer: Healthspan PPO |
$194.75
|
| Rate for Payer: Humana Medicaid |
$88.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.02
|
| Rate for Payer: Molina Healthcare Passport |
$88.25
|
| Rate for Payer: Multiplan PHCS |
$844.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.89
|
| Rate for Payer: UHCCP Medicaid |
$492.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.53
|
|
|
ABD ULTRASOUND COMPLETE
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,351.68 |
| Rate for Payer: Aetna Commercial |
$1,084.16
|
| Rate for Payer: Anthem Medicaid |
$484.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,098.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cigna Commercial |
$1,168.64
|
| Rate for Payer: First Health Commercial |
$1,337.60
|
| Rate for Payer: Humana Commercial |
$1,196.80
|
| Rate for Payer: Humana KY Medicaid |
$484.21
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$489.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,154.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,039.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$493.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,239.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$971.52
|
| Rate for Payer: PHCS Commercial |
$1,351.68
|
| Rate for Payer: United Healthcare All Payer |
$1,239.04
|
|
