|
CT CALC SCORE W/O CONT(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
350T0065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$78.58 |
| 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 |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| 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 |
$78.58
|
| 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 |
$94.30
|
| 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 CALC SCORE W/O CONT(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
350T0065
|
|
Hospital Revenue Code
|
352
|
| 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 CAROT ART ANGIOGRAM W/DYE
|
Professional
|
Both
|
$3,353.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
35000032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$111.63 |
| Max. Negotiated Rate |
$3,353.00 |
| Rate for Payer: Aetna Commercial |
$671.48
|
| Rate for Payer: Anthem Medicaid |
$262.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,353.00
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cigna Commercial |
$816.62
|
| Rate for Payer: Healthspan PPO |
$461.41
|
| Rate for Payer: Humana Medicaid |
$262.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$268.13
|
| Rate for Payer: Molina Healthcare Passport |
$262.87
|
| Rate for Payer: Multiplan PHCS |
$2,011.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,347.10
|
| Rate for Payer: UHCCP Medicaid |
$1,173.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$265.50
|
|
|
CT CAROT ART ANGIOGRAM W/DYE
|
Facility
|
OP
|
$3,353.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
35000032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,218.88 |
| Rate for Payer: Aetna Commercial |
$2,581.81
|
| Rate for Payer: Anthem Medicaid |
$1,153.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cigna Commercial |
$2,782.99
|
| Rate for Payer: First Health Commercial |
$3,185.35
|
| Rate for Payer: Humana Commercial |
$2,850.05
|
| Rate for Payer: Humana KY Medicaid |
$1,153.10
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,164.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,749.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,474.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,176.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,950.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,514.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,039.43
|
| Rate for Payer: PHCS Commercial |
$3,218.88
|
| Rate for Payer: United Healthcare All Payer |
$2,950.64
|
|
|
CT CAROT ART ANGIOGRAM W/DYE
|
Facility
|
IP
|
$3,353.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
35000032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$435.89 |
| Max. Negotiated Rate |
$3,218.88 |
| Rate for Payer: Aetna Commercial |
$2,581.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.34
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cigna Commercial |
$2,782.99
|
| Rate for Payer: First Health Commercial |
$3,185.35
|
| Rate for Payer: Humana Commercial |
$2,850.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,749.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,474.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,950.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,514.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,039.43
|
| Rate for Payer: PHCS Commercial |
$3,218.88
|
| Rate for Payer: United Healthcare All Payer |
$2,950.64
|
|
|
CT CAROT ART ANGIOGRAM W/DYE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
350P0032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$816.62 |
| Rate for Payer: Aetna Commercial |
$671.48
|
| Rate for Payer: Anthem Medicaid |
$262.87
|
| 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 |
$816.62
|
| Rate for Payer: Healthspan PPO |
$461.41
|
| Rate for Payer: Humana Medicaid |
$262.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$268.13
|
| Rate for Payer: Molina Healthcare Passport |
$262.87
|
| 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 |
$265.50
|
|
|
CT CAROT ART ANGIOGRAM W/DYE(T
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
350T0032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$406.64 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
CT CAROT ART ANGIOGRAM W/DYE(T
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
350T0032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem Medicaid |
$1,075.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Humana KY Medicaid |
$1,075.72
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$2,547.84 |
| Rate for Payer: Aetna Commercial |
$2,043.58
|
| Rate for Payer: Anthem Medicaid |
$912.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,070.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$2,202.82
|
| Rate for Payer: First Health Commercial |
$2,521.30
|
| Rate for Payer: Humana Commercial |
$2,255.90
|
| Rate for Payer: Humana KY Medicaid |
$912.71
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$922.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,176.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,958.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$931.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,335.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,990.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.74
|
| Rate for Payer: PHCS Commercial |
$2,547.84
|
| Rate for Payer: United Healthcare All Payer |
$2,335.52
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$2,547.84 |
| Rate for Payer: Aetna Commercial |
$2,043.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,070.12
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$2,202.82
|
| Rate for Payer: First Health Commercial |
$2,521.30
|
| Rate for Payer: Humana Commercial |
$2,255.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,176.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,958.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,335.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,990.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.74
|
| Rate for Payer: PHCS Commercial |
$2,547.84
|
| Rate for Payer: United Healthcare All Payer |
$2,335.52
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Aetna Commercial |
$518.86
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,654.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.53
|
| Rate for Payer: Humana Medicaid |
$243.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.05
|
| Rate for Payer: Molina Healthcare Passport |
$243.19
|
| Rate for Payer: Multiplan PHCS |
$1,592.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,857.80
|
| Rate for Payer: UHCCP Medicaid |
$928.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.62
|
|
|
CT CERVICAL SPINE W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
350P0041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$518.86 |
| Rate for Payer: Aetna Commercial |
$518.86
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| 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 |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.53
|
| Rate for Payer: Humana Medicaid |
$243.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.05
|
| Rate for Payer: Molina Healthcare Passport |
$243.19
|
| 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 |
$245.62
|
|
|
CT CERVICAL SPINE W/CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
350T0041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem Medicaid |
$835.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Humana KY Medicaid |
$835.33
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
CT CERVICAL SPINE W/CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
350T0041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
350P0040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$425.87 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$425.87
|
| Rate for Payer: Healthspan PPO |
$265.77
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
350T0040
|
|
Hospital Revenue Code
|
352
|
| 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 CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$317.46 |
| Max. Negotiated Rate |
$2,344.32 |
| Rate for Payer: Aetna Commercial |
$1,880.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,904.76
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna Commercial |
$2,026.86
|
| Rate for Payer: First Health Commercial |
$2,319.90
|
| Rate for Payer: Humana Commercial |
$2,075.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,002.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,148.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,831.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.02
|
| Rate for Payer: PHCS Commercial |
$2,344.32
|
| Rate for Payer: United Healthcare All Payer |
$2,148.96
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Professional
|
Both
|
$2,442.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$2,442.00 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,442.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna Commercial |
$425.87
|
| Rate for Payer: Healthspan PPO |
$265.77
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,465.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,709.40
|
| Rate for Payer: UHCCP Medicaid |
$854.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,344.32 |
| Rate for Payer: Aetna Commercial |
$1,880.34
|
| Rate for Payer: Anthem Medicaid |
$839.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,904.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna Commercial |
$2,026.86
|
| Rate for Payer: First Health Commercial |
$2,319.90
|
| Rate for Payer: Humana Commercial |
$2,075.70
|
| Rate for Payer: Humana KY Medicaid |
$839.80
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$848.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,002.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$856.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,148.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,831.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.02
|
| Rate for Payer: PHCS Commercial |
$2,344.32
|
| Rate for Payer: United Healthcare All Payer |
$2,148.96
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
350T0040
|
|
Hospital Revenue Code
|
352
|
| 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 CERVICAL SPINE W/O&W/CONT
|
Professional
|
Both
|
$2,866.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$2,866.00 |
| Rate for Payer: Aetna Commercial |
$616.44
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,866.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$609.61
|
| Rate for Payer: Healthspan PPO |
$423.59
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.08
|
| Rate for Payer: Molina Healthcare Passport |
$293.22
|
| Rate for Payer: Multiplan PHCS |
$1,719.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,006.20
|
| Rate for Payer: UHCCP Medicaid |
$1,003.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
|
|
CT CERVICAL SPINE W/O&W/CONT
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,751.36 |
| Rate for Payer: Aetna Commercial |
$2,206.82
|
| Rate for Payer: Anthem Medicaid |
$985.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,235.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$2,378.78
|
| Rate for Payer: First Health Commercial |
$2,722.70
|
| Rate for Payer: Humana Commercial |
$2,436.10
|
| Rate for Payer: Humana KY Medicaid |
$985.62
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$995.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,350.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,115.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,005.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,522.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,149.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.46
|
| Rate for Payer: PHCS Commercial |
$2,751.36
|
| Rate for Payer: United Healthcare All Payer |
$2,522.08
|
|
|
CT CERVICAL SPINE W/O&W/CONT
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$372.58 |
| Max. Negotiated Rate |
$2,751.36 |
| Rate for Payer: Aetna Commercial |
$2,206.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,235.48
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$2,378.78
|
| Rate for Payer: First Health Commercial |
$2,722.70
|
| Rate for Payer: Humana Commercial |
$2,436.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,350.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,115.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$859.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,522.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,149.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.46
|
| Rate for Payer: PHCS Commercial |
$2,751.36
|
| Rate for Payer: United Healthcare All Payer |
$2,522.08
|
|
|
CT CERVICAL SPINE W/O&W/CONT(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
350P0042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$616.44
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$609.61
|
| Rate for Payer: Healthspan PPO |
$423.59
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.08
|
| Rate for Payer: Molina Healthcare Passport |
$293.22
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
|
|
CT CERVICAL SPINE W/O&W/CONT(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
350T0042
|
|
Hospital Revenue Code
|
352
|
| 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
|
|
