|
MYELOGRAM - LUMBOSACRAL
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
32000008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$556.20 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.26
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
|
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 |
$214.27 |
| Rate for Payer: Ambetter Exchange |
$109.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$96.64
|
| Rate for Payer: Anthem Medicaid |
$185.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.82
|
| 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 |
$185.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$158.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.12
|
| Rate for Payer: Molina Healthcare Passport |
$185.41
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$142.81
|
| Rate for Payer: UHCCP Medicaid |
$101.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.85
|
|
|
MYELOGRAM - LUMBOSACRAL(T
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
320T0008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$466.20 |
| 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 |
$1,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.26
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
MYELOGRAM - LUMBOSACRAL(T
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 62304
|
| Hospital Charge Code |
320T0008
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.42 |
| 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 |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| 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 |
$730.00
|
| 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 |
$876.00
|
| 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 |
$1,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.26
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
MYELOGRAM - THORACIC
|
Facility
|
IP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$678.30 |
| 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 |
$1,808.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,967.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.09
|
| Rate for Payer: PHCS Commercial |
$2,170.56
|
| Rate for Payer: United Healthcare All Payer |
$1,989.68
|
|
|
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 |
$1,356.60 |
| Rate for Payer: Ambetter Exchange |
$111.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.63
|
| Rate for Payer: Anthem Medicaid |
$194.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.73
|
| 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 |
$194.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.78
|
| Rate for Payer: Molina Healthcare Passport |
$194.88
|
| Rate for Payer: Multiplan PHCS |
$1,356.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.87
|
| Rate for Payer: UHCCP Medicaid |
$104.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.44
|
|
|
MYELOGRAM - THORACIC
|
Facility
|
OP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
32000007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$730.00 |
| 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 |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,763.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| 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 |
$730.00
|
| 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 |
$876.00
|
| 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 |
$1,808.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,967.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.09
|
| 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 |
$456.00 |
| Rate for Payer: Ambetter Exchange |
$111.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.63
|
| Rate for Payer: Anthem Medicaid |
$194.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.73
|
| 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 |
$194.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.78
|
| Rate for Payer: Molina Healthcare Passport |
$194.88
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.87
|
| Rate for Payer: UHCCP Medicaid |
$104.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.44
|
|
|
MYELOGRAM - THORACIC(T
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62303
|
| Hospital Charge Code |
320T0007
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$516.19 |
| 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 |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| 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 |
$730.00
|
| 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 |
$876.00
|
| 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 |
$1,200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.69
|
| 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 |
$450.30 |
| 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 |
$1,200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.69
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
|
MYELOGRAPHY L-S SPINE
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.71 |
| Max. Negotiated Rate |
$1,293.00 |
| Rate for Payer: Aetna Commercial |
$226.45
|
| Rate for Payer: Ambetter Exchange |
$98.06
|
| Rate for Payer: Anthem Medicaid |
$146.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.67
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cash Price |
$1,077.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$98.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$149.07
|
| Rate for Payer: Molina Healthcare Passport |
$146.15
|
| Rate for Payer: Multiplan PHCS |
$1,293.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.48
|
| Rate for Payer: UHCCP Medicaid |
$754.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.06
|
|
|
MYELOGRAPHY L-S SPINE
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
MYELOGRAPHY L-S SPINE
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
32000273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
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: Ambetter Exchange |
$98.06
|
| Rate for Payer: Anthem Medicaid |
$146.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$98.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.06
|
| 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 |
$127.48
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.06
|
|
|
MYELOGRAPHY L-S SPINE(T
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
320T0273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$689.52 |
| Max. Negotiated Rate |
$1,924.80 |
| Rate for Payer: Aetna Commercial |
$1,543.85
|
| Rate for Payer: Anthem Medicaid |
$689.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,563.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cigna Commercial |
$1,664.15
|
| Rate for Payer: First Health Commercial |
$1,904.75
|
| Rate for Payer: Humana Commercial |
$1,704.25
|
| Rate for Payer: Humana KY Medicaid |
$689.52
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$696.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,644.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,479.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$703.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,764.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,503.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,744.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,383.45
|
| Rate for Payer: PHCS Commercial |
$1,924.80
|
| Rate for Payer: United Healthcare All Payer |
$1,764.40
|
|
|
MYELOGRAPHY L-S SPINE(T
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS 72265
|
| Hospital Charge Code |
320T0273
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.50 |
| Max. Negotiated Rate |
$1,924.80 |
| Rate for Payer: Aetna Commercial |
$1,543.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,563.90
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cigna Commercial |
$1,664.15
|
| Rate for Payer: First Health Commercial |
$1,904.75
|
| Rate for Payer: Humana Commercial |
$1,704.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,644.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,479.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$601.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,764.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,503.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,744.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,383.45
|
| Rate for Payer: PHCS Commercial |
$1,924.80
|
| Rate for Payer: United Healthcare All Payer |
$1,764.40
|
|
|
MYELOGRAPHY NECK SPINE
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
32000271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna Commercial |
$1,704.01
|
| Rate for Payer: Anthem Medicaid |
$761.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,726.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,106.50
|
| Rate for Payer: Cash Price |
$1,106.50
|
| Rate for Payer: Cigna Commercial |
$1,836.79
|
| Rate for Payer: First Health Commercial |
$2,102.35
|
| Rate for Payer: Humana Commercial |
$1,881.05
|
| Rate for Payer: Humana KY Medicaid |
$761.05
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$768.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,814.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,633.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$776.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,947.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,925.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.97
|
| Rate for Payer: PHCS Commercial |
$2,124.48
|
| Rate for Payer: United Healthcare All Payer |
$1,947.44
|
|
|
MYELOGRAPHY NECK SPINE
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
32000271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$663.90 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna Commercial |
$1,704.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,726.14
|
| Rate for Payer: Cash Price |
$1,106.50
|
| Rate for Payer: Cigna Commercial |
$1,836.79
|
| Rate for Payer: First Health Commercial |
$2,102.35
|
| Rate for Payer: Humana Commercial |
$1,881.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,814.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,633.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,947.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,925.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.97
|
| Rate for Payer: PHCS Commercial |
$2,124.48
|
| Rate for Payer: United Healthcare All Payer |
$1,947.44
|
|
|
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 |
$1,327.80 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Ambetter Exchange |
$100.98
|
| Rate for Payer: Anthem Medicaid |
$167.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.98
|
| 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 |
$131.27
|
| Rate for Payer: UHCCP Medicaid |
$774.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.98
|
|
|
MYELOGRAPHY NECK SPINE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
320P0271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$305.82 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Ambetter Exchange |
$100.98
|
| Rate for Payer: Anthem Medicaid |
$167.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.18
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.79
|
| Rate for Payer: Molina Healthcare Passport |
$167.44
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.27
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.98
|
|
|
MYELOGRAPHY NECK SPINE(T
|
Facility
|
OP
|
$2,088.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
320T0271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$718.06 |
| Max. Negotiated Rate |
$2,004.48 |
| Rate for Payer: Aetna Commercial |
$1,607.76
|
| Rate for Payer: Anthem Medicaid |
$718.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,733.04
|
| Rate for Payer: First Health Commercial |
$1,983.60
|
| Rate for Payer: Humana Commercial |
$1,774.80
|
| Rate for Payer: Humana KY Medicaid |
$718.06
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$725.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.72
|
| Rate for Payer: PHCS Commercial |
$2,004.48
|
| Rate for Payer: United Healthcare All Payer |
$1,837.44
|
|
|
MYELOGRAPHY NECK SPINE(T
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
HCPCS 72240
|
| Hospital Charge Code |
320T0271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$626.40 |
| Max. Negotiated Rate |
$2,004.48 |
| Rate for Payer: Aetna Commercial |
$1,607.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.64
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,733.04
|
| Rate for Payer: First Health Commercial |
$1,983.60
|
| Rate for Payer: Humana Commercial |
$1,774.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.72
|
| Rate for Payer: PHCS Commercial |
$2,004.48
|
| Rate for Payer: United Healthcare All Payer |
$1,837.44
|
|
|
MYELOGRAPHY THORACIC SPINE
|
Facility
|
IP
|
$2,431.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$729.30 |
| Max. Negotiated Rate |
$2,333.76 |
| Rate for Payer: Aetna Commercial |
$1,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,896.18
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna Commercial |
$2,017.73
|
| Rate for Payer: First Health Commercial |
$2,309.45
|
| Rate for Payer: Humana Commercial |
$2,066.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,993.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,794.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$729.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,139.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,823.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,114.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,677.39
|
| Rate for Payer: PHCS Commercial |
$2,333.76
|
| Rate for Payer: United Healthcare All Payer |
$2,139.28
|
|
|
MYELOGRAPHY THORACIC SPINE
|
Facility
|
OP
|
$2,431.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$2,333.76 |
| Rate for Payer: Aetna Commercial |
$1,871.87
|
| Rate for Payer: Anthem Medicaid |
$836.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,896.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna Commercial |
$2,017.73
|
| Rate for Payer: First Health Commercial |
$2,309.45
|
| Rate for Payer: Humana Commercial |
$2,066.35
|
| Rate for Payer: Humana KY Medicaid |
$836.02
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$844.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,993.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,794.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,139.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,823.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,114.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,677.39
|
| Rate for Payer: PHCS Commercial |
$2,333.76
|
| Rate for Payer: United Healthcare All Payer |
$2,139.28
|
|
|
MYELOGRAPHY THORACIC SPINE
|
Professional
|
Both
|
$2,431.00
|
|
|
Service Code
|
HCPCS 72255
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$1,458.60 |
| Rate for Payer: Aetna Commercial |
$223.04
|
| Rate for Payer: Ambetter Exchange |
$96.52
|
| Rate for Payer: Anthem Medicaid |
$156.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.82
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna Commercial |
$282.61
|
| Rate for Payer: Healthspan PPO |
$209.00
|
| Rate for Payer: Humana Medicaid |
$156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.38
|
| Rate for Payer: Molina Healthcare Passport |
$156.25
|
| Rate for Payer: Multiplan PHCS |
$1,458.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.48
|
| Rate for Payer: UHCCP Medicaid |
$850.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.52
|
|
