|
CT BRAIN ANGIOGRAPHY (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
320P0995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
CT BRAIN ANGIOGRAPHY (T
|
Facility
|
OP
|
$1,783.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
320T0995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.79 |
| Max. Negotiated Rate |
$1,711.68 |
| Rate for Payer: Aetna Commercial |
$1,372.91
|
| Rate for Payer: Anthem Medicaid |
$613.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.74
|
| Rate for Payer: Cash Price |
$891.50
|
| Rate for Payer: Cigna Commercial |
$1,479.89
|
| Rate for Payer: First Health Commercial |
$1,693.85
|
| Rate for Payer: Humana Commercial |
$1,515.55
|
| Rate for Payer: Humana KY Medicaid |
$613.17
|
| Rate for Payer: Kentucky WC Medicaid |
$619.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.73
|
| Rate for Payer: PHCS Commercial |
$1,711.68
|
| Rate for Payer: United Healthcare All Payer |
$1,569.04
|
|
|
CT BRAIN ANGIOGRAPHY (T
|
Facility
|
IP
|
$1,783.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
320T0995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.79 |
| Max. Negotiated Rate |
$1,711.68 |
| Rate for Payer: Aetna Commercial |
$1,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.74
|
| Rate for Payer: Cash Price |
$891.50
|
| Rate for Payer: Cigna Commercial |
$1,479.89
|
| Rate for Payer: First Health Commercial |
$1,693.85
|
| Rate for Payer: Humana Commercial |
$1,515.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.73
|
| Rate for Payer: PHCS Commercial |
$1,711.68
|
| Rate for Payer: United Healthcare All Payer |
$1,569.04
|
|
|
CT BRAIN/HEAD W/CONTRAST
|
Professional
|
Both
|
$2,572.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$2,572.00 |
| Rate for Payer: Aetna Commercial |
$430.00
|
| Rate for Payer: Anthem Medicaid |
$201.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,572.00
|
| Rate for Payer: Cash Price |
$1,286.00
|
| Rate for Payer: Cash Price |
$1,286.00
|
| Rate for Payer: Cigna Commercial |
$414.23
|
| Rate for Payer: Healthspan PPO |
$295.47
|
| Rate for Payer: Humana Medicaid |
$201.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.62
|
| Rate for Payer: Molina Healthcare Passport |
$201.59
|
| Rate for Payer: Multiplan PHCS |
$1,543.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,800.40
|
| Rate for Payer: UHCCP Medicaid |
$900.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.61
|
|
|
CT BRAIN/HEAD W/CONTRAST
|
Facility
|
OP
|
$2,572.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,469.12 |
| Rate for Payer: Aetna Commercial |
$1,980.44
|
| Rate for Payer: Anthem Medicaid |
$884.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,006.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,286.00
|
| Rate for Payer: Cash Price |
$1,286.00
|
| Rate for Payer: Cigna Commercial |
$2,134.76
|
| Rate for Payer: First Health Commercial |
$2,443.40
|
| Rate for Payer: Humana Commercial |
$2,186.20
|
| Rate for Payer: Humana KY Medicaid |
$884.51
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$893.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,109.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,898.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$902.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,263.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,929.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$514.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$797.32
|
| Rate for Payer: PHCS Commercial |
$2,469.12
|
| Rate for Payer: United Healthcare All Payer |
$2,263.36
|
|
|
CT BRAIN/HEAD W/CONTRAST
|
Facility
|
IP
|
$2,572.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$334.36 |
| Max. Negotiated Rate |
$2,469.12 |
| Rate for Payer: Aetna Commercial |
$1,980.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,006.16
|
| Rate for Payer: Cash Price |
$1,286.00
|
| Rate for Payer: Cigna Commercial |
$2,134.76
|
| Rate for Payer: First Health Commercial |
$2,443.40
|
| Rate for Payer: Humana Commercial |
$2,186.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,109.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,898.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$771.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,263.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,929.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$514.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$797.32
|
| Rate for Payer: PHCS Commercial |
$2,469.12
|
| Rate for Payer: United Healthcare All Payer |
$2,263.36
|
|
|
CT BRAIN/HEAD W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
350P0023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$430.00
|
| Rate for Payer: Anthem Medicaid |
$201.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$414.23
|
| Rate for Payer: Healthspan PPO |
$295.47
|
| Rate for Payer: Humana Medicaid |
$201.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.62
|
| Rate for Payer: Molina Healthcare Passport |
$201.59
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.61
|
|
|
CT BRAIN/HEAD W/CONTRAST(T
|
Facility
|
IP
|
$2,347.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
350T0023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$305.11 |
| Max. Negotiated Rate |
$2,253.12 |
| Rate for Payer: Aetna Commercial |
$1,807.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,830.66
|
| Rate for Payer: Cash Price |
$1,173.50
|
| Rate for Payer: Cigna Commercial |
$1,948.01
|
| Rate for Payer: First Health Commercial |
$2,229.65
|
| Rate for Payer: Humana Commercial |
$1,994.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,924.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,732.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$704.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,065.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,760.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.57
|
| Rate for Payer: PHCS Commercial |
$2,253.12
|
| Rate for Payer: United Healthcare All Payer |
$2,065.36
|
|
|
CT BRAIN/HEAD W/CONTRAST(T
|
Facility
|
OP
|
$2,347.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
350T0023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,253.12 |
| Rate for Payer: Aetna Commercial |
$1,807.19
|
| Rate for Payer: Anthem Medicaid |
$807.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,830.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,173.50
|
| Rate for Payer: Cash Price |
$1,173.50
|
| Rate for Payer: Cigna Commercial |
$1,948.01
|
| Rate for Payer: First Health Commercial |
$2,229.65
|
| Rate for Payer: Humana Commercial |
$1,994.95
|
| Rate for Payer: Humana KY Medicaid |
$807.13
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$815.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,924.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,732.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$823.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,065.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,760.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.57
|
| Rate for Payer: PHCS Commercial |
$2,253.12
|
| Rate for Payer: United Healthcare All Payer |
$2,065.36
|
|
|
CT BRAIN/HEAD W/O CONTRAST
|
Facility
|
OP
|
$2,392.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$1,841.84
|
| Rate for Payer: Anthem Medicaid |
$822.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,865.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: First Health Commercial |
$2,272.40
|
| Rate for Payer: Humana Commercial |
$2,033.20
|
| Rate for Payer: Humana KY Medicaid |
$822.61
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$830.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$478.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.52
|
| Rate for Payer: PHCS Commercial |
$2,296.32
|
| Rate for Payer: United Healthcare All Payer |
$2,104.96
|
|
|
CT BRAIN/HEAD W/O CONTRAST
|
Professional
|
Both
|
$2,392.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna Commercial |
$333.03
|
| Rate for Payer: Anthem Medicaid |
$164.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,392.00
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cigna Commercial |
$332.05
|
| Rate for Payer: Healthspan PPO |
$228.84
|
| Rate for Payer: Humana Medicaid |
$164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.63
|
| Rate for Payer: Molina Healthcare Passport |
$164.34
|
| Rate for Payer: Multiplan PHCS |
$1,435.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,674.40
|
| Rate for Payer: UHCCP Medicaid |
$837.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.98
|
|
|
CT BRAIN/HEAD W/O CONTRAST
|
Facility
|
IP
|
$2,392.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$310.96 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$1,841.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,865.76
|
| Rate for Payer: Cash Price |
$1,196.00
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: First Health Commercial |
$2,272.40
|
| Rate for Payer: Humana Commercial |
$2,033.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$478.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.52
|
| Rate for Payer: PHCS Commercial |
$2,296.32
|
| Rate for Payer: United Healthcare All Payer |
$2,104.96
|
|
|
CT BRAIN/HEAD W/O CONTRAST(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
350P0022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$333.03 |
| Rate for Payer: Aetna Commercial |
$333.03
|
| Rate for Payer: Anthem Medicaid |
$164.34
|
| 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 |
$332.05
|
| Rate for Payer: Healthspan PPO |
$228.84
|
| Rate for Payer: Humana Medicaid |
$164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.63
|
| Rate for Payer: Molina Healthcare Passport |
$164.34
|
| 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 |
$165.98
|
|
|
CT BRAIN/HEAD W/O CONTRAST(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
350T0022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$291.46 |
| Max. Negotiated Rate |
$2,152.32 |
| Rate for Payer: Aetna Commercial |
$1,726.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cigna Commercial |
$1,860.86
|
| Rate for Payer: First Health Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial |
$1,905.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,654.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,972.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.02
|
| Rate for Payer: PHCS Commercial |
$2,152.32
|
| Rate for Payer: United Healthcare All Payer |
$1,972.96
|
|
|
CT BRAIN/HEAD W/O CONTRAST(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
350T0022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,152.32 |
| Rate for Payer: Aetna Commercial |
$1,726.34
|
| Rate for Payer: Anthem Medicaid |
$771.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cigna Commercial |
$1,860.86
|
| Rate for Payer: First Health Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial |
$1,905.70
|
| Rate for Payer: Humana KY Medicaid |
$771.02
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$778.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,654.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,972.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.02
|
| Rate for Payer: PHCS Commercial |
$2,152.32
|
| Rate for Payer: United Healthcare All Payer |
$1,972.96
|
|
|
CT BRAIN/HEAD W/WO CONTRAST
|
Professional
|
Both
|
$2,841.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
35000024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$2,841.00 |
| Rate for Payer: Aetna Commercial |
$520.31
|
| Rate for Payer: Anthem Medicaid |
$245.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,841.00
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cigna Commercial |
$504.69
|
| Rate for Payer: Healthspan PPO |
$357.53
|
| Rate for Payer: Humana Medicaid |
$245.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.61
|
| Rate for Payer: Molina Healthcare Passport |
$245.70
|
| Rate for Payer: Multiplan PHCS |
$1,704.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,988.70
|
| Rate for Payer: UHCCP Medicaid |
$994.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.16
|
|
|
CT BRAIN/HEAD W/WO CONTRAST
|
Facility
|
OP
|
$2,841.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
35000024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,727.36 |
| Rate for Payer: Aetna Commercial |
$2,187.57
|
| Rate for Payer: Anthem Medicaid |
$977.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cigna Commercial |
$2,358.03
|
| Rate for Payer: First Health Commercial |
$2,698.95
|
| Rate for Payer: Humana Commercial |
$2,414.85
|
| Rate for Payer: Humana KY Medicaid |
$977.02
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$986.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,329.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,096.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$996.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,500.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.71
|
| Rate for Payer: PHCS Commercial |
$2,727.36
|
| Rate for Payer: United Healthcare All Payer |
$2,500.08
|
|
|
CT BRAIN/HEAD W/WO CONTRAST
|
Facility
|
IP
|
$2,841.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
35000024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$369.33 |
| Max. Negotiated Rate |
$2,727.36 |
| Rate for Payer: Aetna Commercial |
$2,187.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.98
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cigna Commercial |
$2,358.03
|
| Rate for Payer: First Health Commercial |
$2,698.95
|
| Rate for Payer: Humana Commercial |
$2,414.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,329.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,096.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,500.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.71
|
| Rate for Payer: PHCS Commercial |
$2,727.36
|
| Rate for Payer: United Healthcare All Payer |
$2,500.08
|
|
|
CT BRAIN/HEAD W/WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
350P0024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$520.31 |
| Rate for Payer: Aetna Commercial |
$520.31
|
| Rate for Payer: Anthem Medicaid |
$245.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$504.69
|
| Rate for Payer: Healthspan PPO |
$357.53
|
| Rate for Payer: Humana Medicaid |
$245.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.61
|
| Rate for Payer: Molina Healthcare Passport |
$245.70
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.16
|
|
|
CT BRAIN/HEAD W/WO CONTRAST(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
350T0024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,511.36 |
| Rate for Payer: Aetna Commercial |
$2,014.32
|
| Rate for Payer: Anthem Medicaid |
$899.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,040.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cigna Commercial |
$2,171.28
|
| Rate for Payer: First Health Commercial |
$2,485.20
|
| Rate for Payer: Humana Commercial |
$2,223.60
|
| Rate for Payer: Humana KY Medicaid |
$899.64
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$908.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,145.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,930.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$917.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,302.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,962.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.96
|
| Rate for Payer: PHCS Commercial |
$2,511.36
|
| Rate for Payer: United Healthcare All Payer |
$2,302.08
|
|
|
CT BRAIN/HEAD W/WO CONTRAST(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
350T0024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$340.08 |
| Max. Negotiated Rate |
$2,511.36 |
| Rate for Payer: Aetna Commercial |
$2,014.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,040.48
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cigna Commercial |
$2,171.28
|
| Rate for Payer: First Health Commercial |
$2,485.20
|
| Rate for Payer: Humana Commercial |
$2,223.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,145.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,930.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$784.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,302.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,962.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.96
|
| Rate for Payer: PHCS Commercial |
$2,511.36
|
| Rate for Payer: United Healthcare All Payer |
$2,302.08
|
|
|
CT CALC SCORE W/O CONT
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$2,367.00 |
| Rate for Payer: Aetna Commercial |
$111.45
|
| Rate for Payer: Anthem Medicaid |
$65.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,367.00
|
| Rate for Payer: Cash Price |
$1,183.50
|
| Rate for Payer: Cash Price |
$1,183.50
|
| Rate for Payer: Cigna Commercial |
$139.61
|
| Rate for Payer: Healthspan PPO |
$69.71
|
| Rate for Payer: Humana Medicaid |
$65.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.53
|
| Rate for Payer: Molina Healthcare Passport |
$65.23
|
| Rate for Payer: Multiplan PHCS |
$1,420.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,656.90
|
| Rate for Payer: UHCCP Medicaid |
$828.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.88
|
|
|
CT CALC SCORE W/O CONT
|
Facility
|
OP
|
$2,367.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$2,272.32 |
| Rate for Payer: Aetna Commercial |
$1,822.59
|
| Rate for Payer: Anthem Medicaid |
$814.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,846.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$1,183.50
|
| Rate for Payer: Cash Price |
$1,183.50
|
| Rate for Payer: Cigna Commercial |
$1,964.61
|
| Rate for Payer: First Health Commercial |
$2,248.65
|
| Rate for Payer: Humana Commercial |
$2,011.95
|
| Rate for Payer: Humana KY Medicaid |
$814.01
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$822.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,940.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,746.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$830.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,082.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,775.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$733.77
|
| Rate for Payer: PHCS Commercial |
$2,272.32
|
| Rate for Payer: United Healthcare All Payer |
$2,082.96
|
|
|
CT CALC SCORE W/O CONT
|
Facility
|
IP
|
$2,367.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$307.71 |
| Max. Negotiated Rate |
$2,272.32 |
| Rate for Payer: Aetna Commercial |
$1,822.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,846.26
|
| Rate for Payer: Cash Price |
$1,183.50
|
| Rate for Payer: Cigna Commercial |
$1,964.61
|
| Rate for Payer: First Health Commercial |
$2,248.65
|
| Rate for Payer: Humana Commercial |
$2,011.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,940.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,746.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,082.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,775.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$733.77
|
| Rate for Payer: PHCS Commercial |
$2,272.32
|
| Rate for Payer: United Healthcare All Payer |
$2,082.96
|
|
|
CT CALC SCORE W/O CONT(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
350P0065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$139.61 |
| Rate for Payer: Aetna Commercial |
$111.45
|
| Rate for Payer: Anthem Medicaid |
$65.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$139.61
|
| Rate for Payer: Healthspan PPO |
$69.71
|
| Rate for Payer: Humana Medicaid |
$65.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.53
|
| Rate for Payer: Molina Healthcare Passport |
$65.23
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.88
|
|
