|
CT INNER EAR W/CONTRAST
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
35000026
|
|
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 INNER EAR W/CONTRAST
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
35000026
|
|
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 INNER EAR W/CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
350P0026
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$572.89 |
| Rate for Payer: Aetna Commercial |
$572.89
|
| Rate for Payer: Anthem Medicaid |
$212.12
|
| 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 |
$476.86
|
| Rate for Payer: Healthspan PPO |
$393.66
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$216.36
|
| Rate for Payer: Molina Healthcare Passport |
$212.12
|
| 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 |
$214.24
|
|
|
CT INNER EAR W/CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
350T0026
|
|
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 INNER EAR W/CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
350T0026
|
|
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
|
|
|
C-TIP SWAN GANZ CATH 7FR
|
Facility
|
OP
|
$1,885.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.05 |
| Max. Negotiated Rate |
$1,809.61 |
| Rate for Payer: Aetna Commercial |
$1,451.46
|
| Rate for Payer: Anthem Medicaid |
$648.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.31
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cigna Commercial |
$1,564.56
|
| Rate for Payer: First Health Commercial |
$1,790.76
|
| Rate for Payer: Humana Commercial |
$1,602.26
|
| Rate for Payer: Humana KY Medicaid |
$648.25
|
| Rate for Payer: Kentucky WC Medicaid |
$654.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.35
|
| Rate for Payer: PHCS Commercial |
$1,809.61
|
| Rate for Payer: United Healthcare All Payer |
$1,658.81
|
|
|
C-TIP SWAN GANZ CATH 7FR
|
Facility
|
IP
|
$1,885.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.05 |
| Max. Negotiated Rate |
$1,809.61 |
| Rate for Payer: Aetna Commercial |
$1,451.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.31
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cigna Commercial |
$1,564.56
|
| Rate for Payer: First Health Commercial |
$1,790.76
|
| Rate for Payer: Humana Commercial |
$1,602.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.35
|
| Rate for Payer: PHCS Commercial |
$1,809.61
|
| Rate for Payer: United Healthcare All Payer |
$1,658.81
|
|
|
CT LOWER EXTREMITY W/CONTRAS(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
350P0056
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$495.07 |
| Rate for Payer: Aetna Commercial |
$495.07
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| 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 |
$445.74
|
| Rate for Payer: Healthspan PPO |
$340.19
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| 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 |
$211.51
|
|
|
CT LOWER EXTREMITY W/CONTRAS(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
350T0056
|
|
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 LOWER EXTREMITY W/CONTRAS(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
350T0056
|
|
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 LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
35000056
|
|
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 LOWER EXTREMITY W/CONTRAST
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
35000056
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Aetna Commercial |
$495.07
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| 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 |
$445.74
|
| Rate for Payer: Healthspan PPO |
$340.19
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| 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 |
$211.51
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
35000056
|
|
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 LOWER EXTREMITY W/O DYE
|
Professional
|
Both
|
$2,442.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
35000055
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$2,442.00 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Anthem Medicaid |
$180.72
|
| 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 |
$378.15
|
| Rate for Payer: Healthspan PPO |
$261.42
|
| Rate for Payer: Humana Medicaid |
$180.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.33
|
| Rate for Payer: Molina Healthcare Passport |
$180.72
|
| 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 |
$182.53
|
|
|
CT LOWER EXTREMITY W/O DYE
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
35000055
|
|
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 LOWER EXTREMITY W/O DYE
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
35000055
|
|
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 LOWER EXTREMITY W/O DYE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
350P0055
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$380.43 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Anthem Medicaid |
$180.72
|
| 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 |
$378.15
|
| Rate for Payer: Healthspan PPO |
$261.42
|
| Rate for Payer: Humana Medicaid |
$180.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.33
|
| Rate for Payer: Molina Healthcare Passport |
$180.72
|
| 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 |
$182.53
|
|
|
CT LOWER EXTREMITY W/O DYE(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
350T0055
|
|
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 LOWER EXTREMITY W/O DYE(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
350T0055
|
|
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 LUMBAR SPINE W CONTRAST
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
35000047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| 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 |
$77.88
|
| 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 LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
35000047
|
|
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 LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
35000047
|
|
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 LUMBAR SPINE W CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
350P0047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| 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 |
$77.88
|
| 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 LUMBAR SPINE W CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
350T0047
|
|
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 LUMBAR SPINE W CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
350T0047
|
|
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
|
|
