|
CT FACIAL BONES W/CONTRAST
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,571.84 |
| Rate for Payer: Aetna Commercial |
$2,062.83
|
| Rate for Payer: Anthem Medicaid |
$921.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,089.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cigna Commercial |
$2,223.57
|
| Rate for Payer: First Health Commercial |
$2,545.05
|
| Rate for Payer: Humana Commercial |
$2,277.15
|
| Rate for Payer: Humana KY Medicaid |
$921.31
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$930.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,196.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,977.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$939.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,357.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,009.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$830.49
|
| Rate for Payer: PHCS Commercial |
$2,571.84
|
| Rate for Payer: United Healthcare All Payer |
$2,357.52
|
|
|
CT FACIAL BONES W/CONTRAST
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$348.27 |
| Max. Negotiated Rate |
$2,571.84 |
| Rate for Payer: Aetna Commercial |
$2,062.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,089.62
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cigna Commercial |
$2,223.57
|
| Rate for Payer: First Health Commercial |
$2,545.05
|
| Rate for Payer: Humana Commercial |
$2,277.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,196.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,977.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$803.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,357.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,009.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$830.49
|
| Rate for Payer: PHCS Commercial |
$2,571.84
|
| Rate for Payer: United Healthcare All Payer |
$2,357.52
|
|
|
CT FACIAL BONES W/CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
350P0029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$515.45
|
| Rate for Payer: Anthem Medicaid |
$208.70
|
| 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 |
$450.67
|
| Rate for Payer: Healthspan PPO |
$354.19
|
| Rate for Payer: Humana Medicaid |
$208.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.87
|
| Rate for Payer: Molina Healthcare Passport |
$208.70
|
| 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 |
$210.79
|
|
|
CT FACIAL BONES W/CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
350T0029
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
350T0029
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/O CONTRAST
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/O CONTRAST
|
Professional
|
Both
|
$2,442.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$2,442.00 |
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Anthem Medicaid |
$176.55
|
| 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 |
$376.69
|
| Rate for Payer: Healthspan PPO |
$264.01
|
| Rate for Payer: Humana Medicaid |
$176.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.08
|
| Rate for Payer: Molina Healthcare Passport |
$176.55
|
| 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 |
$178.32
|
|
|
CT FACIAL BONES W/O CONTRAST
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/O CONTRAST(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
350P0028
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$384.21 |
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Anthem Medicaid |
$176.55
|
| 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 |
$376.69
|
| Rate for Payer: Healthspan PPO |
$264.01
|
| Rate for Payer: Humana Medicaid |
$176.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.08
|
| Rate for Payer: Molina Healthcare Passport |
$176.55
|
| 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 |
$178.32
|
|
|
CT FACIAL BONES W/O CONTRAST(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
350T0028
|
|
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 FACIAL BONES W/O CONTRAST(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
350T0028
|
|
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 FACIAL BONES W/WO CONTRA
|
Professional
|
Both
|
$2,866.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$90.01 |
| Max. Negotiated Rate |
$2,866.00 |
| Rate for Payer: Aetna Commercial |
$626.38
|
| Rate for Payer: Anthem Medicaid |
$252.22
|
| 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 |
$547.15
|
| Rate for Payer: Healthspan PPO |
$430.42
|
| Rate for Payer: Humana Medicaid |
$252.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.26
|
| Rate for Payer: Molina Healthcare Passport |
$252.22
|
| 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 |
$254.74
|
|
|
CT FACIAL BONES W/WO CONTRA
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/WO CONTRA
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/WO CONTRA(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
350P0030
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$626.38 |
| Rate for Payer: Aetna Commercial |
$626.38
|
| Rate for Payer: Anthem Medicaid |
$252.22
|
| 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 |
$547.15
|
| Rate for Payer: Healthspan PPO |
$430.42
|
| Rate for Payer: Humana Medicaid |
$252.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.26
|
| Rate for Payer: Molina Healthcare Passport |
$252.22
|
| 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 |
$254.74
|
|
|
CT FACIAL BONES W/WO CONTRA(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
350T0030
|
|
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 FACIAL BONES W/WO CONTRA(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
350T0030
|
|
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 FUSION/UNLISTED PROC
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 77399
|
| Hospital Charge Code |
33300024
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.18
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
CT FUSION/UNLISTED PROC
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 77399
|
| Hospital Charge Code |
33300024
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$129.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$129.99
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$131.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.18
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
350P0018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$875.14 |
| Rate for Payer: Aetna Commercial |
$875.14
|
| 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 |
$826.15
|
| Rate for Payer: Healthspan PPO |
$709.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$261.51
|
| 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
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
350T0018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$261.51 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$875.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$826.15
|
| Rate for Payer: Healthspan PPO |
$709.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$261.51
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Humana KY Medicaid |
$773.78
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
350T0018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
