|
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
|
|
|
CT PELVIS W/O CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72192
|
| Hospital Charge Code |
350P0049
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$415.73 |
| Rate for Payer: Aetna Commercial |
$381.84
|
| Rate for Payer: Anthem Medicaid |
$206.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$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 |
$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 |
$208.37
|
|
|
CT PELVIS W/O CONTRAST(T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72192
|
| Hospital Charge Code |
350T0049
|
|
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 PELVIS W/O CONTRAST(T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72192
|
| Hospital Charge Code |
350T0049
|
|
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 PELVIS W & WO CONTRAST
|
Professional
|
Both
|
$2,841.00
|
|
|
Service Code
|
HCPCS 72194
|
| Hospital Charge Code |
35000051
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$2,841.00 |
| Rate for Payer: Aetna Commercial |
$611.78
|
| Rate for Payer: Anthem Medicaid |
$281.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,841.00
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cigna Commercial |
$591.74
|
| Rate for Payer: Healthspan PPO |
$420.39
|
| Rate for Payer: Humana Medicaid |
$281.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$286.72
|
| Rate for Payer: Molina Healthcare Passport |
$281.10
|
| Rate for Payer: Multiplan PHCS |
$1,704.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,988.70
|
| Rate for Payer: UHCCP Medicaid |
$994.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$283.91
|
|
|
CT PELVIS W & WO CONTRAST
|
Facility
|
OP
|
$2,841.00
|
|
|
Service Code
|
HCPCS 72194
|
| Hospital Charge Code |
35000051
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,727.36 |
| Rate for Payer: Cigna Commercial |
$2,358.03
|
| Rate for Payer: Aetna Commercial |
$2,187.57
|
| Rate for Payer: Anthem Medicaid |
$977.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: First Health Commercial |
$2,698.95
|
| Rate for Payer: Humana Commercial |
$2,414.85
|
| Rate for Payer: Humana KY Medicaid |
$977.02
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$986.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,329.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,096.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$996.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,500.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.71
|
| Rate for Payer: PHCS Commercial |
$2,727.36
|
| Rate for Payer: United Healthcare All Payer |
$2,500.08
|
|
|
CT PELVIS W & WO CONTRAST
|
Facility
|
IP
|
$2,841.00
|
|
|
Service Code
|
HCPCS 72194
|
| Hospital Charge Code |
35000051
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$369.33 |
| Max. Negotiated Rate |
$2,727.36 |
| Rate for Payer: Aetna Commercial |
$2,187.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.98
|
| Rate for Payer: Cash Price |
$1,420.50
|
| Rate for Payer: Cigna Commercial |
$2,358.03
|
| Rate for Payer: First Health Commercial |
$2,698.95
|
| Rate for Payer: Humana Commercial |
$2,414.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,329.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,096.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,500.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.71
|
| Rate for Payer: PHCS Commercial |
$2,727.36
|
| Rate for Payer: United Healthcare All Payer |
$2,500.08
|
|
|
CT PELVIS W & WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72194
|
| Hospital Charge Code |
350P0051
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$611.78 |
| Rate for Payer: Aetna Commercial |
$611.78
|
| Rate for Payer: Anthem Medicaid |
$281.10
|
| 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 |
$591.74
|
| Rate for Payer: Healthspan PPO |
$420.39
|
| Rate for Payer: Humana Medicaid |
$281.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$286.72
|
| Rate for Payer: Molina Healthcare Passport |
$281.10
|
| 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 |
$283.91
|
|
|
CT PELVIS W & WO CONTRAST(T
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 72194
|
| Hospital Charge Code |
350T0051
|
|
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 PELVIS W & WO CONTRAST(T
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS 72194
|
| Hospital Charge Code |
350T0051
|
|
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
|
|
|
[C]TRANXENE(CLORAZ 3.75MG/1TAB
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
NDC 13107031901
|
| Hospital Charge Code |
25000123
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.58
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
[C]TRANXENE(CLORAZ 3.75MG/1TAB
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
NDC 13107031901
|
| Hospital Charge Code |
25000123
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$20.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.58
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Humana KY Medicaid |
$20.98
|
| Rate for Payer: Kentucky WC Medicaid |
$21.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
CT SCAN FOR THERAPY GUIDE
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
HCPCS 77014
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$162.89 |
| Max. Negotiated Rate |
$1,202.88 |
| Rate for Payer: Aetna Commercial |
$964.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$977.34
|
| Rate for Payer: Cash Price |
$626.50
|
| Rate for Payer: Cigna Commercial |
$1,039.99
|
| Rate for Payer: First Health Commercial |
$1,190.35
|
| Rate for Payer: Humana Commercial |
$1,065.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,027.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$924.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,102.64
|
| Rate for Payer: Ohio Health Group HMO |
$939.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$388.43
|
| Rate for Payer: PHCS Commercial |
$1,202.88
|
| Rate for Payer: United Healthcare All Payer |
$1,102.64
|
|
|
CT SCAN FOR THERAPY GUIDE
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
HCPCS 77014
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$162.89 |
| Max. Negotiated Rate |
$1,202.88 |
| Rate for Payer: Aetna Commercial |
$964.81
|
| Rate for Payer: Anthem Medicaid |
$430.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$977.34
|
| Rate for Payer: Cash Price |
$626.50
|
| Rate for Payer: Cigna Commercial |
$1,039.99
|
| Rate for Payer: First Health Commercial |
$1,190.35
|
| Rate for Payer: Humana Commercial |
$1,065.05
|
| Rate for Payer: Humana KY Medicaid |
$430.91
|
| Rate for Payer: Kentucky WC Medicaid |
$435.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,027.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$924.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$439.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,102.64
|
| Rate for Payer: Ohio Health Group HMO |
$939.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$388.43
|
| Rate for Payer: PHCS Commercial |
$1,202.88
|
| Rate for Payer: United Healthcare All Payer |
$1,102.64
|
|
|
CT SCAN FOR THERAPY GUIDE
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 77014
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.99 |
| Max. Negotiated Rate |
$1,253.00 |
| Rate for Payer: Aetna Commercial |
$281.66
|
| Rate for Payer: Anthem Medicaid |
$119.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,253.00
|
| Rate for Payer: Cash Price |
$626.50
|
| Rate for Payer: Cash Price |
$626.50
|
| Rate for Payer: Cigna Commercial |
$250.86
|
| Rate for Payer: Healthspan PPO |
$263.92
|
| Rate for Payer: Humana Medicaid |
$119.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.49
|
| Rate for Payer: Molina Healthcare Passport |
$119.11
|
| Rate for Payer: Multiplan PHCS |
$751.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.10
|
| Rate for Payer: UHCCP Medicaid |
$438.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.30
|
|
|
CT SCAN FOR THERAPY GUIDE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 77014
|
| Hospital Charge Code |
350P0019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$281.66 |
| Rate for Payer: Aetna Commercial |
$281.66
|
| Rate for Payer: Anthem Medicaid |
$119.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$250.86
|
| Rate for Payer: Healthspan PPO |
$263.92
|
| Rate for Payer: Humana Medicaid |
$119.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.49
|
| Rate for Payer: Molina Healthcare Passport |
$119.11
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.30
|
|
|
CT SCAN FOR THERAPY GUIDE(T
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
HCPCS 77014
|
| Hospital Charge Code |
350T0019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$1,082.88 |
| Rate for Payer: Aetna Commercial |
$868.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.84
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.24
|
| Rate for Payer: First Health Commercial |
$1,071.60
|
| Rate for Payer: Humana Commercial |
$958.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.64
|
| Rate for Payer: Ohio Health Group HMO |
$846.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.68
|
| Rate for Payer: PHCS Commercial |
$1,082.88
|
| Rate for Payer: United Healthcare All Payer |
$992.64
|
|
|
CT SCAN FOR THERAPY GUIDE(T
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
HCPCS 77014
|
| Hospital Charge Code |
350T0019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$1,082.88 |
| Rate for Payer: Aetna Commercial |
$868.56
|
| Rate for Payer: Anthem Medicaid |
$387.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.84
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.24
|
| Rate for Payer: First Health Commercial |
$1,071.60
|
| Rate for Payer: Humana Commercial |
$958.80
|
| Rate for Payer: Humana KY Medicaid |
$387.92
|
| Rate for Payer: Kentucky WC Medicaid |
$391.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.64
|
| Rate for Payer: Ohio Health Group HMO |
$846.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.68
|
| Rate for Payer: PHCS Commercial |
$1,082.88
|
| Rate for Payer: United Healthcare All Payer |
$992.64
|
|
|
CT SCREENING CALC SCORE SP
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000089
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CT SCREENING CALC SCORE SP
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000089
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$110.01 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CT THORACIC SPINE W CONTRAST
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
35000044
|
|
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 THORACIC SPINE W CONTRAST
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
35000044
|
|
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 THORACIC SPINE W CONTRAST
|
Professional
|
Both
|
$2,679.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
35000044
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Aetna Commercial |
$519.39
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| 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 |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.90
|
| 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 |
$1,607.40
|
| 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 |
$245.62
|
|
|
CT THORACIC SPINE W CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
350P0044
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$519.39 |
| Rate for Payer: Aetna Commercial |
$519.39
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| 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 |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.90
|
| 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 |
$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 |
$245.62
|
|
|
CT THORACIC SPINE W CONTRAST(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
350T0044
|
|
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
|
|
