|
CT THORACIC SPINE W CONTRAST(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 72129
|
| Hospital Charge Code |
350T0044
|
|
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 THORACIC SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72128
|
| Hospital Charge Code |
350T0043
|
|
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 THORACIC SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 72128
|
| Hospital Charge Code |
350T0043
|
|
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 THORACIC SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72128
|
| Hospital Charge Code |
35000043
|
|
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 THORACIC SPINE W/O CONTRAST
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72128
|
| Hospital Charge Code |
350P0043
|
|
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 THORACIC SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72128
|
| Hospital Charge Code |
35000043
|
|
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 THORACIC SPINE W/O CONTRAST
|
Professional
|
Both
|
$2,467.00
|
|
|
Service Code
|
HCPCS 72128
|
| Hospital Charge Code |
35000043
|
|
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 THORACIC SPINE WWO CONTRAST
|
Facility
|
IP
|
$2,778.00
|
|
|
Service Code
|
HCPCS 72130
|
| Hospital Charge Code |
35000045
|
|
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 THORACIC SPINE WWO CONTRAST
|
Facility
|
OP
|
$2,528.00
|
|
|
Service Code
|
HCPCS 72130
|
| Hospital Charge Code |
350T0045
|
|
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 THORACIC SPINE WWO CONTRAST
|
Facility
|
OP
|
$2,778.00
|
|
|
Service Code
|
HCPCS 72130
|
| Hospital Charge Code |
35000045
|
|
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 THORACIC SPINE WWO CONTRAST
|
Professional
|
Both
|
$2,778.00
|
|
|
Service Code
|
HCPCS 72130
|
| Hospital Charge Code |
35000045
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$2,778.00 |
| Rate for Payer: Aetna Commercial |
$616.99
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| 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 |
$609.07
|
| 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 |
$1,666.80
|
| 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 |
$296.15
|
|
|
CT THORACIC SPINE WWO CONTRAST
|
Facility
|
IP
|
$2,528.00
|
|
|
Service Code
|
HCPCS 72130
|
| Hospital Charge Code |
350T0045
|
|
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 THORACIC SPINE WWO CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72130
|
| Hospital Charge Code |
350P0045
|
|
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 |
$609.07
|
| 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 THORAX LUNG CANCER SCR C-
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$79.82 |
| Max. Negotiated Rate |
$589.44 |
| Rate for Payer: Aetna Commercial |
$472.78
|
| Rate for Payer: Anthem Medicaid |
$211.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cigna Commercial |
$509.62
|
| Rate for Payer: First Health Commercial |
$583.30
|
| Rate for Payer: Humana Commercial |
$521.90
|
| Rate for Payer: Humana KY Medicaid |
$211.15
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$213.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$503.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$540.32
|
| Rate for Payer: Ohio Health Group HMO |
$460.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.34
|
| Rate for Payer: PHCS Commercial |
$589.44
|
| Rate for Payer: United Healthcare All Payer |
$540.32
|
|
|
CT THORAX LUNG CANCER SCR C-
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Anthem Medicaid |
$116.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$614.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Humana Medicaid |
$116.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.41
|
| Rate for Payer: Molina Healthcare Passport |
$116.09
|
| Rate for Payer: Multiplan PHCS |
$368.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.80
|
| Rate for Payer: UHCCP Medicaid |
$214.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.25
|
|
|
CT THORAX LUNG CANCER SCR C-
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$79.82 |
| Max. Negotiated Rate |
$589.44 |
| Rate for Payer: Aetna Commercial |
$472.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.92
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cigna Commercial |
$509.62
|
| Rate for Payer: First Health Commercial |
$583.30
|
| Rate for Payer: Humana Commercial |
$521.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$503.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$540.32
|
| Rate for Payer: Ohio Health Group HMO |
$460.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.34
|
| Rate for Payer: PHCS Commercial |
$589.44
|
| Rate for Payer: United Healthcare All Payer |
$540.32
|
|
|
CT THORAX LUNG CANCER SCR C-
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
350P0020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$118.41 |
| Rate for Payer: Anthem Medicaid |
$116.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Humana Medicaid |
$116.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.41
|
| Rate for Payer: Molina Healthcare Passport |
$116.09
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.25
|
|
|
CT THORAX LUNG CANCER SCR C-
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
350T0020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$517.44 |
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.42
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna Commercial |
$447.37
|
| Rate for Payer: First Health Commercial |
$512.05
|
| Rate for Payer: Humana Commercial |
$458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$441.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$397.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.32
|
| Rate for Payer: Ohio Health Group HMO |
$404.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.09
|
| Rate for Payer: PHCS Commercial |
$517.44
|
| Rate for Payer: United Healthcare All Payer |
$474.32
|
|
|
CT THORAX LUNG CANCER SCR C-
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
350T0020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$70.07 |
| Max. Negotiated Rate |
$517.44 |
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Anthem Medicaid |
$185.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna Commercial |
$447.37
|
| Rate for Payer: First Health Commercial |
$512.05
|
| Rate for Payer: Humana Commercial |
$458.15
|
| Rate for Payer: Humana KY Medicaid |
$185.36
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$187.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$441.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$397.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.32
|
| Rate for Payer: Ohio Health Group HMO |
$404.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.09
|
| Rate for Payer: PHCS Commercial |
$517.44
|
| Rate for Payer: United Healthcare All Payer |
$474.32
|
|
|
CT UPPER EXTREMITY W/DYE
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
35000053
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$2,547.84 |
| Rate for Payer: Aetna Commercial |
$2,043.58
|
| Rate for Payer: Anthem Medicaid |
$912.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,070.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$2,202.82
|
| Rate for Payer: First Health Commercial |
$2,521.30
|
| Rate for Payer: Humana Commercial |
$2,255.90
|
| Rate for Payer: Humana KY Medicaid |
$912.71
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$922.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,176.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,958.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$931.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,335.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,990.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.74
|
| Rate for Payer: PHCS Commercial |
$2,547.84
|
| Rate for Payer: United Healthcare All Payer |
$2,335.52
|
|
|
CT UPPER EXTREMITY W/DYE
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
35000053
|
|
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 UPPER EXTREMITY W/DYE
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
35000053
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Aetna Commercial |
$491.85
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,654.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cash Price |
$1,327.00
|
| Rate for Payer: Cigna Commercial |
$444.63
|
| Rate for Payer: Healthspan PPO |
$337.98
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,592.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,857.80
|
| Rate for Payer: UHCCP Medicaid |
$928.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT UPPER EXTREMITY W/DYE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
350P0053
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$491.85 |
| Rate for Payer: Aetna Commercial |
$491.85
|
| 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 |
$444.63
|
| Rate for Payer: Healthspan PPO |
$337.98
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT UPPER EXTREMITY W/DYE(T
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
350T0053
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem Medicaid |
$835.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Humana KY Medicaid |
$835.33
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
CT UPPER EXTREMITY W/DYE(T
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
350T0053
|
|
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
|
|
