|
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
|
|
|
CT NECK-SOFT TISSUE W/O DYE
|
Facility
|
IP
|
$2,492.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$323.96 |
| Max. Negotiated Rate |
$2,392.32 |
| Rate for Payer: Aetna Commercial |
$1,918.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,943.76
|
| Rate for Payer: Cash Price |
$1,246.00
|
| Rate for Payer: Cigna Commercial |
$2,068.36
|
| Rate for Payer: First Health Commercial |
$2,367.40
|
| Rate for Payer: Humana Commercial |
$2,118.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,043.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,839.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,192.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,869.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.52
|
| Rate for Payer: PHCS Commercial |
$2,392.32
|
| Rate for Payer: United Healthcare All Payer |
$2,192.96
|
|
|
CT NECK-SOFT TISSUE W/O DYE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
350P0034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$396.39 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Anthem Medicaid |
$182.78
|
| 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 |
$382.68
|
| Rate for Payer: Healthspan PPO |
$272.38
|
| Rate for Payer: Humana Medicaid |
$182.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.44
|
| Rate for Payer: Molina Healthcare Passport |
$182.78
|
| 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 |
$184.61
|
|
|
CT NECK-SOFT TISSUE W/O DYE(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
350T0034
|
|
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 NECK-SOFT TISSUE W/O DYE(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
350T0034
|
|
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 NECK-SOFT TISSUE W/WO CON(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
350P0036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$614.73 |
| Rate for Payer: Aetna Commercial |
$614.73
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$544.47
|
| Rate for Payer: Healthspan PPO |
$422.41
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
|
|
CT NECK-SOFT TISSUE W/WO CON(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
350T0036
|
|
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 NECK-SOFT TISSUE W/WO CON(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
350T0036
|
|
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 NECK-SOFT TISSUE W/WO CONT
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
35000036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$2,891.00 |
| Rate for Payer: Aetna Commercial |
$614.73
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,891.00
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$544.47
|
| Rate for Payer: Healthspan PPO |
$422.41
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$1,734.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,023.70
|
| Rate for Payer: UHCCP Medicaid |
$1,011.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
|
|
CT NECK-SOFT TISSUE W/WO CONT
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
35000036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem Medicaid |
$994.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Humana KY Medicaid |
$994.21
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,004.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,014.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$896.21
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CT NECK-SOFT TISSUE W/WO CONT
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
35000036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$375.83 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$896.21
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CT ORBIT W/WO CONTRAST
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$2,891.00 |
| Rate for Payer: Aetna Commercial |
$628.11
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,891.00
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$562.12
|
| Rate for Payer: Healthspan PPO |
$431.61
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$1,734.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,023.70
|
| Rate for Payer: UHCCP Medicaid |
$1,011.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
|
|
CT ORBIT W/WO CONTRAST
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$375.83 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$896.21
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CT ORBIT W/WO CONTRAST
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem Medicaid |
$994.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Humana KY Medicaid |
$994.21
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,004.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,014.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$896.21
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CT ORBIT W/WO CONTRAST(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
350P0027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$628.11 |
| Rate for Payer: Aetna Commercial |
$628.11
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$562.12
|
| Rate for Payer: Healthspan PPO |
$431.61
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
|
|
CT ORBIT W/WO CONTRAST(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
350T0027
|
|
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 ORBIT W/WO CONTRAST(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
350T0027
|
|
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 PELVIS W/CONTRAST
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
35000050
|
|
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 PELVIS W/CONTRAST
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
35000050
|
|
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 PELVIS W/CONTRAST
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
35000050
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Aetna Commercial |
$493.80
|
| Rate for Payer: Anthem Medicaid |
$234.50
|
| 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 |
$481.66
|
| Rate for Payer: Healthspan PPO |
$339.32
|
| Rate for Payer: Humana Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.19
|
| Rate for Payer: Molina Healthcare Passport |
$234.50
|
| 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 |
$236.84
|
|
|
CT PELVIS W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
350P0050
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$493.80 |
| Rate for Payer: Aetna Commercial |
$493.80
|
| Rate for Payer: Anthem Medicaid |
$234.50
|
| 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 |
$481.66
|
| Rate for Payer: Healthspan PPO |
$339.32
|
| Rate for Payer: Humana Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.19
|
| Rate for Payer: Molina Healthcare Passport |
$234.50
|
| 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 |
$236.84
|
|
|
CT PELVIS W/CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
350T0050
|
|
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 PELVIS W/CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
350T0050
|
|
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 PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72192
|
| Hospital Charge Code |
35000049
|
|
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 PELVIS W/O CONTRAST
|
Professional
|
Both
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72192
|
| Hospital Charge Code |
35000049
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$2,467.00 |
| Rate for Payer: Aetna Commercial |
$381.84
|
| Rate for Payer: Anthem Medicaid |
$206.31
|
| 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 |
$415.73
|
| Rate for Payer: Healthspan PPO |
$262.38
|
| Rate for Payer: Humana Medicaid |
$206.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.44
|
| Rate for Payer: Molina Healthcare Passport |
$206.31
|
| 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 |
$208.37
|
|
