|
CT CERVICAL SPINE W/O&W/CONT(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
350T0042
|
|
Hospital Revenue Code
|
352
|
| 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 CHEST W/CONTRAST
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
35000038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| 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 |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,070.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| 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 |
$158.88
|
| 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 |
$190.66
|
| 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 CHEST W/CONTRAST
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
35000038
|
|
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 CHEST W/CONTRAST
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
35000038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$79.16 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Aetna Commercial |
$520.01
|
| Rate for Payer: Anthem Medicaid |
$244.31
|
| 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 |
$503.50
|
| Rate for Payer: Healthspan PPO |
$357.32
|
| Rate for Payer: Humana Medicaid |
$244.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.20
|
| Rate for Payer: Molina Healthcare Passport |
$244.31
|
| 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 |
$246.75
|
|
|
CT CHEST W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
350P0038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$520.01 |
| Rate for Payer: Aetna Commercial |
$520.01
|
| Rate for Payer: Anthem Medicaid |
$244.31
|
| 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 |
$503.50
|
| Rate for Payer: Healthspan PPO |
$357.32
|
| Rate for Payer: Humana Medicaid |
$244.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.20
|
| Rate for Payer: Molina Healthcare Passport |
$244.31
|
| 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 |
$246.75
|
|
|
CT CHEST W/CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
350T0038
|
|
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 CHEST W/CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
350T0038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| 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 |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| 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 |
$158.88
|
| 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 |
$190.66
|
| 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 CHEST W/O CONTRAST
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
35000037
|
|
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 CHEST W/O CONTRAST
|
Professional
|
Both
|
$2,442.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
35000037
|
|
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 CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
35000037
|
|
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 CHEST W/O CONTRAST(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
350P0037
|
|
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 CHEST W/O CONTRAST(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
350T0037
|
|
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 CHEST W/O CONTRAST(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
350T0037
|
|
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 CHEST W/WO CONTRAST
|
Professional
|
Both
|
$2,866.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
35000039
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$2,866.00 |
| Rate for Payer: Aetna Commercial |
$625.47
|
| Rate for Payer: Anthem Medicaid |
$297.79
|
| 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 |
$618.82
|
| Rate for Payer: Healthspan PPO |
$429.79
|
| Rate for Payer: Humana Medicaid |
$297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.75
|
| Rate for Payer: Molina Healthcare Passport |
$297.79
|
| 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 |
$300.77
|
|
|
CT CHEST W/WO CONTRAST
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
35000039
|
|
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 CHEST W/WO CONTRAST
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
35000039
|
|
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 CHEST W/WO CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
350P0039
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$625.47 |
| Rate for Payer: Aetna Commercial |
$625.47
|
| Rate for Payer: Anthem Medicaid |
$297.79
|
| 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 |
$618.82
|
| Rate for Payer: Healthspan PPO |
$429.79
|
| Rate for Payer: Humana Medicaid |
$297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.75
|
| Rate for Payer: Molina Healthcare Passport |
$297.79
|
| 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 |
$300.77
|
|
|
CT CHEST W/WO CONTRAST(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
350T0039
|
|
Hospital Revenue Code
|
352
|
| 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 CHEST W/WO CONTRAST(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
350T0039
|
|
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
|
|
|
CT COLONOGRAPHY DX
|
Facility
|
OP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem Medicaid |
$857.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Humana KY Medicaid |
$857.00
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$865.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$874.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.52
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
CT COLONOGRAPHY DX
|
Facility
|
IP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$323.96 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.52
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
CT COLONOGRAPHY DX
|
Professional
|
Both
|
$2,492.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$147.96 |
| Max. Negotiated Rate |
$2,492.00 |
| Rate for Payer: Aetna Commercial |
$464.72
|
| Rate for Payer: Anthem Medicaid |
$296.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,492.00
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$634.38
|
| Rate for Payer: Healthspan PPO |
$399.18
|
| Rate for Payer: Humana Medicaid |
$296.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.97
|
| Rate for Payer: Molina Healthcare Passport |
$296.05
|
| Rate for Payer: Multiplan PHCS |
$1,495.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,744.40
|
| Rate for Payer: UHCCP Medicaid |
$872.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.01
|
|
|
CT COLONOGRAPHY DX(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
350P0008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$634.38 |
| Rate for Payer: Aetna Commercial |
$464.72
|
| Rate for Payer: Anthem Medicaid |
$296.05
|
| 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 |
$634.38
|
| Rate for Payer: Healthspan PPO |
$399.18
|
| Rate for Payer: Humana Medicaid |
$296.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.97
|
| Rate for Payer: Molina Healthcare Passport |
$296.05
|
| 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 |
$299.01
|
|
|
CT COLONOGRAPHY DX(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
350T0008
|
|
Hospital Revenue Code
|
350
|
| 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 COLONOGRAPHY DX(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
350T0008
|
|
Hospital Revenue Code
|
350
|
| 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
|
|
