|
CT LUMBAR SPINE W/O CONTRAST
|
Professional
|
Both
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
35000046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$2,467.00 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,467.00
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cash Price |
$1,233.50
|
| 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 |
$1,480.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,726.90
|
| Rate for Payer: UHCCP Medicaid |
$863.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
35000046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,368.32 |
| Rate for Payer: Aetna Commercial |
$1,899.59
|
| Rate for Payer: Anthem Medicaid |
$848.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,924.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cigna Commercial |
$2,047.61
|
| Rate for Payer: First Health Commercial |
$2,343.65
|
| Rate for Payer: Humana Commercial |
$2,096.95
|
| Rate for Payer: Humana KY Medicaid |
$848.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$857.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,022.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,820.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,170.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,850.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.77
|
| Rate for Payer: PHCS Commercial |
$2,368.32
|
| Rate for Payer: United Healthcare All Payer |
$2,170.96
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
35000046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$320.71 |
| Max. Negotiated Rate |
$2,368.32 |
| Rate for Payer: Aetna Commercial |
$1,899.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,924.26
|
| Rate for Payer: Cash Price |
$1,233.50
|
| Rate for Payer: Cigna Commercial |
$2,047.61
|
| Rate for Payer: First Health Commercial |
$2,343.65
|
| Rate for Payer: Humana Commercial |
$2,096.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,022.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,820.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,170.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,850.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.77
|
| Rate for Payer: PHCS Commercial |
$2,368.32
|
| Rate for Payer: United Healthcare All Payer |
$2,170.96
|
|
|
CT LUMBAR SPINE W/O CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
350P0046
|
|
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 |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| 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 |
$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 LUMBAR SPINE W/O CONTRAST(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
350T0046
|
|
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/O CONTRAST(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
350T0046
|
|
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 LUMBAR SPINE W WO CONTRAS(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
350P0048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$616.99 |
| Rate for Payer: Aetna Commercial |
$616.99
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$611.81
|
| Rate for Payer: Healthspan PPO |
$423.96
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.08
|
| Rate for Payer: Molina Healthcare Passport |
$293.22
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
|
|
CT LUMBAR SPINE W WO CONTRAS(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
350T0048
|
|
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 LUMBAR SPINE W WO CONTRAS(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
350T0048
|
|
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 LUMBAR SPINE W WO CONTRAST
|
Professional
|
Both
|
$2,866.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
35000048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$2,866.00 |
| Rate for Payer: Aetna Commercial |
$616.99
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,866.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$611.81
|
| Rate for Payer: Healthspan PPO |
$423.96
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.08
|
| Rate for Payer: Molina Healthcare Passport |
$293.22
|
| Rate for Payer: Multiplan PHCS |
$1,719.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,006.20
|
| Rate for Payer: UHCCP Medicaid |
$1,003.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
|
|
CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
35000048
|
|
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 LUMBAR SPINE W WO CONTRAST
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
35000048
|
|
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 LWR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
35000057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$361.14 |
| Max. Negotiated Rate |
$2,666.88 |
| Rate for Payer: Aetna Commercial |
$2,139.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,166.84
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cigna Commercial |
$2,305.74
|
| Rate for Payer: First Health Commercial |
$2,639.10
|
| Rate for Payer: Humana Commercial |
$2,361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,277.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$833.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,444.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,083.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.18
|
| Rate for Payer: PHCS Commercial |
$2,666.88
|
| Rate for Payer: United Healthcare All Payer |
$2,444.64
|
|
|
CT LWR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
35000057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,666.88 |
| Rate for Payer: Aetna Commercial |
$2,139.06
|
| Rate for Payer: Anthem Medicaid |
$955.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,166.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cigna Commercial |
$2,305.74
|
| Rate for Payer: First Health Commercial |
$2,639.10
|
| Rate for Payer: Humana Commercial |
$2,361.30
|
| Rate for Payer: Humana KY Medicaid |
$955.35
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$965.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,277.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,050.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$974.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,444.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,083.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$861.18
|
| Rate for Payer: PHCS Commercial |
$2,666.88
|
| Rate for Payer: United Healthcare All Payer |
$2,444.64
|
|
|
CT LWR EXTREMITY W/O&W/DYE
|
Professional
|
Both
|
$2,778.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
35000057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$2,778.00 |
| Rate for Payer: Aetna Commercial |
$611.62
|
| Rate for Payer: Anthem Medicaid |
$252.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,778.00
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cigna Commercial |
$553.09
|
| Rate for Payer: Healthspan PPO |
$420.28
|
| Rate for Payer: Humana Medicaid |
$252.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.85
|
| Rate for Payer: Molina Healthcare Passport |
$252.79
|
| Rate for Payer: Multiplan PHCS |
$1,666.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,944.60
|
| Rate for Payer: UHCCP Medicaid |
$972.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.32
|
|
|
CT LWR EXTREMITY W/O&W/DYE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
350P0057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$611.62 |
| Rate for Payer: Aetna Commercial |
$611.62
|
| Rate for Payer: Anthem Medicaid |
$252.79
|
| 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 |
$553.09
|
| Rate for Payer: Healthspan PPO |
$420.28
|
| Rate for Payer: Humana Medicaid |
$252.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.85
|
| Rate for Payer: Molina Healthcare Passport |
$252.79
|
| 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 |
$255.32
|
|
|
CT LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
IP
|
$2,528.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
350T0057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$328.64 |
| Max. Negotiated Rate |
$2,426.88 |
| Rate for Payer: Aetna Commercial |
$1,946.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,971.84
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cigna Commercial |
$2,098.24
|
| Rate for Payer: First Health Commercial |
$2,401.60
|
| Rate for Payer: Humana Commercial |
$2,148.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,072.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,865.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$758.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,224.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$505.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.68
|
| Rate for Payer: PHCS Commercial |
$2,426.88
|
| Rate for Payer: United Healthcare All Payer |
$2,224.64
|
|
|
CT LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
OP
|
$2,528.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
350T0057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,426.88 |
| Rate for Payer: Aetna Commercial |
$1,946.56
|
| Rate for Payer: Anthem Medicaid |
$869.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,971.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cigna Commercial |
$2,098.24
|
| Rate for Payer: First Health Commercial |
$2,401.60
|
| Rate for Payer: Humana Commercial |
$2,148.80
|
| Rate for Payer: Humana KY Medicaid |
$869.38
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$878.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,072.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,865.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,224.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,896.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$505.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.68
|
| Rate for Payer: PHCS Commercial |
$2,426.88
|
| Rate for Payer: United Healthcare All Payer |
$2,224.64
|
|
|
CT NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
35000035
|
|
Hospital Revenue Code
|
352
|
| 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 NECK-SOFT TISSUE W/CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
350P0035
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$507.24 |
| Rate for Payer: Aetna Commercial |
$507.24
|
| 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 |
$450.94
|
| Rate for Payer: Healthspan PPO |
$348.55
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| 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 NECK-SOFT TISSUE W/CONTRAST
|
Professional
|
Both
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
35000035
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Aetna Commercial |
$507.24
|
| Rate for Payer: Anthem Medicaid |
$212.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,679.00
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cigna Commercial |
$450.94
|
| Rate for Payer: Healthspan PPO |
$348.55
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$216.36
|
| Rate for Payer: Molina Healthcare Passport |
$212.12
|
| Rate for Payer: Multiplan PHCS |
$1,607.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,875.30
|
| Rate for Payer: UHCCP Medicaid |
$937.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$214.24
|
|
|
CT NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
350T0035
|
|
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 NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
350T0035
|
|
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 NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
35000035
|
|
Hospital Revenue Code
|
352
|
| 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 NECK-SOFT TISSUE W/O DYE
|
Facility
|
OP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
352
|
| 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
|
|
