|
MYELOGRAM LUMBAR/THORAC SPINE
|
Facility
|
OP
|
$2,334.00
|
|
|
Service Code
|
HCPCS 62305
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.42 |
| Max. Negotiated Rate |
$2,240.64 |
| Rate for Payer: Aetna Commercial |
$1,797.18
|
| Rate for Payer: Anthem Medicaid |
$802.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,820.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,937.22
|
| Rate for Payer: First Health Commercial |
$2,217.30
|
| Rate for Payer: Humana Commercial |
$1,983.90
|
| Rate for Payer: Humana KY Medicaid |
$802.66
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$810.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,913.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,722.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$818.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,053.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,750.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$466.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$723.54
|
| Rate for Payer: PHCS Commercial |
$2,240.64
|
| Rate for Payer: United Healthcare All Payer |
$2,053.92
|
|
|
MYELOGRAM LUMBAR/THORAC SPINE
|
Facility
|
IP
|
$2,334.00
|
|
|
Service Code
|
HCPCS 62305
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.42 |
| Max. Negotiated Rate |
$2,240.64 |
| Rate for Payer: Aetna Commercial |
$1,797.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,820.52
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$1,937.22
|
| Rate for Payer: First Health Commercial |
$2,217.30
|
| Rate for Payer: Humana Commercial |
$1,983.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,913.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,722.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,053.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,750.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$466.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$723.54
|
| Rate for Payer: PHCS Commercial |
$2,240.64
|
| Rate for Payer: United Healthcare All Payer |
$2,053.92
|
|
|
MYELOGRAM LUMBAR/THORAC SPINE
|
Professional
|
Both
|
$2,334.00
|
|
|
Service Code
|
HCPCS 62305
|
| Hospital Charge Code |
32000009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$2,334.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.82
|
| Rate for Payer: Anthem Medicaid |
$104.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,334.00
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cash Price |
$1,167.00
|
| Rate for Payer: Cigna Commercial |
$224.50
|
| Rate for Payer: Humana Medicaid |
$104.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.62
|
| Rate for Payer: Molina Healthcare Passport |
$104.53
|
| Rate for Payer: Multiplan PHCS |
$1,400.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,633.80
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.58
|
|
|
MYELOGRAM LUMBAR/THORAC SPIN(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 62305
|
| Hospital Charge Code |
320P0009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.82
|
| Rate for Payer: Anthem Medicaid |
$104.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$224.50
|
| Rate for Payer: Humana Medicaid |
$104.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.62
|
| Rate for Payer: Molina Healthcare Passport |
$104.53
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.58
|
|
|
MYELOGRAM LUMBAR/THORAC SPIN(T
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 62305
|
| Hospital Charge Code |
320T0009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.02 |
| Max. Negotiated Rate |
$1,491.84 |
| Rate for Payer: Aetna Commercial |
$1,196.58
|
| Rate for Payer: Anthem Medicaid |
$534.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,289.82
|
| Rate for Payer: First Health Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial |
$1,320.90
|
| Rate for Payer: Humana KY Medicaid |
$534.42
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$539.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.74
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
MYELOGRAM LUMBAR/THORAC SPIN(T
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 62305
|
| Hospital Charge Code |
320T0009
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.02 |
| Max. Negotiated Rate |
$1,491.84 |
| Rate for Payer: Aetna Commercial |
$1,196.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.12
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,289.82
|
| Rate for Payer: First Health Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial |
$1,320.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.74
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
MYELOGRAM - LUMBOSACRAL
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.13 |
| Max. Negotiated Rate |
$1,728.96 |
| Rate for Payer: Aetna Commercial |
$1,386.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.78
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cigna Commercial |
$1,494.83
|
| Rate for Payer: First Health Commercial |
$1,710.95
|
| Rate for Payer: Humana Commercial |
$1,530.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.31
|
| Rate for Payer: PHCS Commercial |
$1,728.96
|
| Rate for Payer: United Healthcare All Payer |
$1,584.88
|
|
|
MYELOGRAM - LUMBOSACRAL
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$1,801.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$96.64
|
| Rate for Payer: Anthem Medicaid |
$99.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,801.00
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cigna Commercial |
$214.27
|
| Rate for Payer: Humana Medicaid |
$99.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$158.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.77
|
| Rate for Payer: Molina Healthcare Passport |
$99.77
|
| Rate for Payer: Multiplan PHCS |
$1,080.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.70
|
| Rate for Payer: UHCCP Medicaid |
$101.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.77
|
|
|
MYELOGRAM - LUMBOSACRAL
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.13 |
| Max. Negotiated Rate |
$1,728.96 |
| Rate for Payer: Molina Healthcare Medicaid |
$631.79
|
| Rate for Payer: Aetna Commercial |
$1,386.77
|
| Rate for Payer: Anthem Medicaid |
$619.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cigna Commercial |
$1,494.83
|
| Rate for Payer: First Health Commercial |
$1,710.95
|
| Rate for Payer: Humana Commercial |
$1,530.85
|
| Rate for Payer: Humana KY Medicaid |
$619.36
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$625.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.31
|
| Rate for Payer: PHCS Commercial |
$1,728.96
|
| Rate for Payer: United Healthcare All Payer |
$1,584.88
|
|
|
MYELOGRAM - LUMBOSACRAL(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
320P0008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$96.64
|
| Rate for Payer: Anthem Medicaid |
$99.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$214.27
|
| Rate for Payer: Humana Medicaid |
$99.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$158.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.77
|
| Rate for Payer: Molina Healthcare Passport |
$99.77
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$101.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.77
|
|
|
MYELOGRAM - LUMBOSACRAL(T
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
320T0008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,440.96 |
| Rate for Payer: Aetna Commercial |
$1,155.77
|
| Rate for Payer: Anthem Medicaid |
$516.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cigna Commercial |
$1,245.83
|
| Rate for Payer: First Health Commercial |
$1,425.95
|
| Rate for Payer: Humana Commercial |
$1,275.85
|
| Rate for Payer: Humana KY Medicaid |
$516.19
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$521.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.31
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
|
MYELOGRAM - LUMBOSACRAL(T
|
Facility
|
IP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
320T0008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,440.96 |
| Rate for Payer: Aetna Commercial |
$1,155.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cigna Commercial |
$1,245.83
|
| Rate for Payer: First Health Commercial |
$1,425.95
|
| Rate for Payer: Humana Commercial |
$1,275.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.31
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
|
MYELOGRAM - THORACIC
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.63 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.63
|
| Rate for Payer: Anthem Medicaid |
$102.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,261.00
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: Humana Medicaid |
$102.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.83
|
| Rate for Payer: Molina Healthcare Passport |
$102.77
|
| Rate for Payer: Multiplan PHCS |
$1,356.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,582.70
|
| Rate for Payer: UHCCP Medicaid |
$104.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.80
|
|
|
MYELOGRAM - THORACIC
|
Facility
|
IP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$2,170.56 |
| Rate for Payer: Aetna Commercial |
$1,740.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,763.58
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cigna Commercial |
$1,876.63
|
| Rate for Payer: First Health Commercial |
$2,147.95
|
| Rate for Payer: Humana Commercial |
$1,921.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,854.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,668.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,989.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,695.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.91
|
| Rate for Payer: PHCS Commercial |
$2,170.56
|
| Rate for Payer: United Healthcare All Payer |
$1,989.68
|
|
|
MYELOGRAM - THORACIC
|
Facility
|
OP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.93 |
| Max. Negotiated Rate |
$2,170.56 |
| Rate for Payer: Aetna Commercial |
$1,740.97
|
| Rate for Payer: Anthem Medicaid |
$777.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,763.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cigna Commercial |
$1,876.63
|
| Rate for Payer: First Health Commercial |
$2,147.95
|
| Rate for Payer: Humana Commercial |
$1,921.85
|
| Rate for Payer: Humana KY Medicaid |
$777.56
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$785.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,854.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,668.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$793.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,989.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,695.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.91
|
| Rate for Payer: PHCS Commercial |
$2,170.56
|
| Rate for Payer: United Healthcare All Payer |
$1,989.68
|
|
|
MYELOGRAM - THORACIC(P
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
320P0007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.63 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.63
|
| Rate for Payer: Anthem Medicaid |
$102.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: Humana Medicaid |
$102.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.83
|
| Rate for Payer: Molina Healthcare Passport |
$102.77
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$104.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.80
|
|
|
MYELOGRAM - THORACIC(T
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
320T0007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,440.96 |
| Rate for Payer: Aetna Commercial |
$1,155.77
|
| Rate for Payer: Anthem Medicaid |
$516.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cigna Commercial |
$1,245.83
|
| Rate for Payer: First Health Commercial |
$1,425.95
|
| Rate for Payer: Humana Commercial |
$1,275.85
|
| Rate for Payer: Humana KY Medicaid |
$516.19
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$521.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.31
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
|
MYELOGRAM - THORACIC(T
|
Facility
|
IP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
320T0007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,440.96 |
| Rate for Payer: Aetna Commercial |
$1,155.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cigna Commercial |
$1,245.83
|
| Rate for Payer: First Health Commercial |
$1,425.95
|
| Rate for Payer: Humana Commercial |
$1,275.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.31
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
|
MYELOGRAPHY L-S SPINE
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.71 |
| Max. Negotiated Rate |
$2,087.00 |
| Rate for Payer: Aetna Commercial |
$226.45
|
| Rate for Payer: Anthem Medicaid |
$146.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,087.00
|
| Rate for Payer: Cash Price |
$1,043.50
|
| Rate for Payer: Cash Price |
$1,043.50
|
| Rate for Payer: Cigna Commercial |
$270.22
|
| Rate for Payer: Healthspan PPO |
$212.19
|
| Rate for Payer: Humana Medicaid |
$146.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.07
|
| Rate for Payer: Molina Healthcare Passport |
$146.15
|
| Rate for Payer: Multiplan PHCS |
$1,252.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,460.90
|
| Rate for Payer: UHCCP Medicaid |
$730.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.61
|
|
|
MYELOGRAPHY L-S SPINE
|
Facility
|
IP
|
$2,087.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.31 |
| Max. Negotiated Rate |
$2,003.52 |
| Rate for Payer: Aetna Commercial |
$1,606.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,627.86
|
| Rate for Payer: Cash Price |
$1,043.50
|
| Rate for Payer: Cigna Commercial |
$1,732.21
|
| Rate for Payer: First Health Commercial |
$1,982.65
|
| Rate for Payer: Humana Commercial |
$1,773.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.97
|
| Rate for Payer: PHCS Commercial |
$2,003.52
|
| Rate for Payer: United Healthcare All Payer |
$1,836.56
|
|
|
MYELOGRAPHY L-S SPINE
|
Facility
|
OP
|
$2,087.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.31 |
| Max. Negotiated Rate |
$2,003.52 |
| Rate for Payer: Aetna Commercial |
$1,606.99
|
| Rate for Payer: Anthem Medicaid |
$717.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,627.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,043.50
|
| Rate for Payer: Cash Price |
$1,043.50
|
| Rate for Payer: Cigna Commercial |
$1,732.21
|
| Rate for Payer: First Health Commercial |
$1,982.65
|
| Rate for Payer: Humana Commercial |
$1,773.95
|
| Rate for Payer: Humana KY Medicaid |
$717.72
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$725.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.97
|
| Rate for Payer: PHCS Commercial |
$2,003.52
|
| Rate for Payer: United Healthcare All Payer |
$1,836.56
|
|
|
MYELOGRAPHY L-S SPINE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
320P0273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$270.22 |
| Rate for Payer: Aetna Commercial |
$226.45
|
| Rate for Payer: Anthem Medicaid |
$146.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$270.22
|
| Rate for Payer: Healthspan PPO |
$212.19
|
| Rate for Payer: Humana Medicaid |
$146.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.07
|
| Rate for Payer: Molina Healthcare Passport |
$146.15
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.61
|
|
|
MYELOGRAPHY L-S SPINE(T
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
320T0273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.81 |
| Max. Negotiated Rate |
$1,859.52 |
| Rate for Payer: Aetna Commercial |
$1,491.49
|
| Rate for Payer: Anthem Medicaid |
$666.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,510.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$968.50
|
| Rate for Payer: Cash Price |
$968.50
|
| Rate for Payer: Cigna Commercial |
$1,607.71
|
| Rate for Payer: First Health Commercial |
$1,840.15
|
| Rate for Payer: Humana Commercial |
$1,646.45
|
| Rate for Payer: Humana KY Medicaid |
$666.13
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$672.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,588.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,429.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$679.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,704.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,452.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.47
|
| Rate for Payer: PHCS Commercial |
$1,859.52
|
| Rate for Payer: United Healthcare All Payer |
$1,704.56
|
|
|
MYELOGRAPHY L-S SPINE(T
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
320T0273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.81 |
| Max. Negotiated Rate |
$1,859.52 |
| Rate for Payer: Aetna Commercial |
$1,491.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,510.86
|
| Rate for Payer: Cash Price |
$968.50
|
| Rate for Payer: Cigna Commercial |
$1,607.71
|
| Rate for Payer: First Health Commercial |
$1,840.15
|
| Rate for Payer: Humana Commercial |
$1,646.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,588.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,429.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,704.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,452.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.47
|
| Rate for Payer: PHCS Commercial |
$1,859.52
|
| Rate for Payer: United Healthcare All Payer |
$1,704.56
|
|
|
MYELOGRAPHY NECK SPINE
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
32000271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$2,213.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Anthem Medicaid |
$167.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,213.00
|
| Rate for Payer: Cash Price |
$1,106.50
|
| Rate for Payer: Cash Price |
$1,106.50
|
| Rate for Payer: Cigna Commercial |
$305.82
|
| Rate for Payer: Healthspan PPO |
$228.54
|
| Rate for Payer: Humana Medicaid |
$167.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.79
|
| Rate for Payer: Molina Healthcare Passport |
$167.44
|
| Rate for Payer: Multiplan PHCS |
$1,327.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,549.10
|
| Rate for Payer: UHCCP Medicaid |
$774.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.11
|
|
