|
CT BRAIN ANGIOGRAPHY
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
32000995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.90 |
| Max. Negotiated Rate |
$1,903.68 |
| Rate for Payer: Aetna Commercial |
$1,526.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,546.74
|
| Rate for Payer: Cash Price |
$991.50
|
| Rate for Payer: Cigna Commercial |
$1,645.89
|
| Rate for Payer: First Health Commercial |
$1,883.85
|
| Rate for Payer: Humana Commercial |
$1,685.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,725.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.27
|
| Rate for Payer: PHCS Commercial |
$1,903.68
|
| Rate for Payer: United Healthcare All Payer |
$1,745.04
|
|
|
CT BRAIN ANGIOGRAPHY
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
32000995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$694.05 |
| Max. Negotiated Rate |
$1,388.10 |
| Rate for Payer: Cash Price |
$991.50
|
| Rate for Payer: Multiplan PHCS |
$1,189.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,388.10
|
| Rate for Payer: UHCCP Medicaid |
$694.05
|
|
|
CT BRAIN ANGIOGRAPHY
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
32000995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.90 |
| Max. Negotiated Rate |
$1,903.68 |
| Rate for Payer: Aetna Commercial |
$1,526.91
|
| Rate for Payer: Anthem Medicaid |
$681.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,546.74
|
| Rate for Payer: Cash Price |
$991.50
|
| Rate for Payer: Cigna Commercial |
$1,645.89
|
| Rate for Payer: First Health Commercial |
$1,883.85
|
| Rate for Payer: Humana Commercial |
$1,685.55
|
| Rate for Payer: Humana KY Medicaid |
$681.95
|
| Rate for Payer: Kentucky WC Medicaid |
$688.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,725.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.27
|
| Rate for Payer: PHCS Commercial |
$1,903.68
|
| Rate for Payer: United Healthcare All Payer |
$1,745.04
|
|
|
CT BRAIN ANGIOGRAPHY (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
320P0995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
CT BRAIN ANGIOGRAPHY (T
|
Facility
|
IP
|
$1,783.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
320T0995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.90 |
| Max. Negotiated Rate |
$1,711.68 |
| Rate for Payer: Aetna Commercial |
$1,372.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.74
|
| Rate for Payer: Cash Price |
$891.50
|
| Rate for Payer: Cigna Commercial |
$1,479.89
|
| Rate for Payer: First Health Commercial |
$1,693.85
|
| Rate for Payer: Humana Commercial |
$1,515.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,551.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,230.27
|
| Rate for Payer: PHCS Commercial |
$1,711.68
|
| Rate for Payer: United Healthcare All Payer |
$1,569.04
|
|
|
CT BRAIN ANGIOGRAPHY (T
|
Facility
|
OP
|
$1,783.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
320T0995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.90 |
| Max. Negotiated Rate |
$1,711.68 |
| Rate for Payer: Aetna Commercial |
$1,372.91
|
| Rate for Payer: Anthem Medicaid |
$613.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.74
|
| Rate for Payer: Cash Price |
$891.50
|
| Rate for Payer: Cigna Commercial |
$1,479.89
|
| Rate for Payer: First Health Commercial |
$1,693.85
|
| Rate for Payer: Humana Commercial |
$1,515.55
|
| Rate for Payer: Humana KY Medicaid |
$613.17
|
| Rate for Payer: Kentucky WC Medicaid |
$619.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,551.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,230.27
|
| Rate for Payer: PHCS Commercial |
$1,711.68
|
| Rate for Payer: United Healthcare All Payer |
$1,569.04
|
|
|
CT BRAIN/HEAD W/CONTRAST
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,615.04 |
| Rate for Payer: Aetna Commercial |
$2,097.48
|
| Rate for Payer: Anthem Medicaid |
$936.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,124.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cigna Commercial |
$2,260.92
|
| Rate for Payer: First Health Commercial |
$2,587.80
|
| Rate for Payer: Humana Commercial |
$2,315.40
|
| Rate for Payer: Humana KY Medicaid |
$936.78
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$946.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,233.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,010.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$955.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,397.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,043.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,179.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,369.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,879.56
|
| Rate for Payer: PHCS Commercial |
$2,615.04
|
| Rate for Payer: United Healthcare All Payer |
$2,397.12
|
|
|
CT BRAIN/HEAD W/CONTRAST
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$817.20 |
| Max. Negotiated Rate |
$2,615.04 |
| Rate for Payer: Aetna Commercial |
$2,097.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,124.72
|
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cigna Commercial |
$2,260.92
|
| Rate for Payer: First Health Commercial |
$2,587.80
|
| Rate for Payer: Humana Commercial |
$2,315.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,233.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,010.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$817.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,397.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,043.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,179.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,369.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,879.56
|
| Rate for Payer: PHCS Commercial |
$2,615.04
|
| Rate for Payer: United Healthcare All Payer |
$2,397.12
|
|
|
CT BRAIN/HEAD W/CONTRAST
|
Professional
|
Both
|
$2,724.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$1,634.40 |
| Rate for Payer: Aetna Commercial |
$430.00
|
| Rate for Payer: Ambetter Exchange |
$136.72
|
| Rate for Payer: Anthem Medicaid |
$201.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.06
|
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cash Price |
$1,362.00
|
| Rate for Payer: Cigna Commercial |
$414.23
|
| Rate for Payer: Healthspan PPO |
$295.47
|
| Rate for Payer: Humana Medicaid |
$201.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.62
|
| Rate for Payer: Molina Healthcare Passport |
$201.59
|
| Rate for Payer: Multiplan PHCS |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.74
|
| Rate for Payer: UHCCP Medicaid |
$953.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.72
|
|
|
CT BRAIN/HEAD W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
350P0023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$430.00
|
| Rate for Payer: Ambetter Exchange |
$136.72
|
| Rate for Payer: Anthem Medicaid |
$201.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.06
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$414.23
|
| Rate for Payer: Healthspan PPO |
$295.47
|
| Rate for Payer: Humana Medicaid |
$201.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.62
|
| Rate for Payer: Molina Healthcare Passport |
$201.59
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.74
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.72
|
|
|
CT BRAIN/HEAD W/CONTRAST(T
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
350T0023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,399.04 |
| Rate for Payer: Aetna Commercial |
$1,924.23
|
| Rate for Payer: Anthem Medicaid |
$859.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,949.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: Cigna Commercial |
$2,074.17
|
| Rate for Payer: First Health Commercial |
$2,374.05
|
| Rate for Payer: Humana Commercial |
$2,124.15
|
| Rate for Payer: Humana KY Medicaid |
$859.41
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$868.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,049.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,844.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$876.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,199.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,874.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,999.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,174.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,724.31
|
| Rate for Payer: PHCS Commercial |
$2,399.04
|
| Rate for Payer: United Healthcare All Payer |
$2,199.12
|
|
|
CT BRAIN/HEAD W/CONTRAST(T
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
350T0023
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$2,399.04 |
| Rate for Payer: Aetna Commercial |
$1,924.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,949.22
|
| Rate for Payer: Cash Price |
$1,249.50
|
| Rate for Payer: Cigna Commercial |
$2,074.17
|
| Rate for Payer: First Health Commercial |
$2,374.05
|
| Rate for Payer: Humana Commercial |
$2,124.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,049.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,844.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$749.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,199.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,874.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,999.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,174.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,724.31
|
| Rate for Payer: PHCS Commercial |
$2,399.04
|
| Rate for Payer: United Healthcare All Payer |
$2,199.12
|
|
|
CT BRAIN/HEAD W/O CONTRAST
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
CT BRAIN/HEAD W/O CONTRAST
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$1,522.20 |
| Rate for Payer: Aetna Commercial |
$333.03
|
| Rate for Payer: Ambetter Exchange |
$98.41
|
| Rate for Payer: Anthem Medicaid |
$164.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.09
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$332.05
|
| Rate for Payer: Healthspan PPO |
$228.84
|
| Rate for Payer: Humana Medicaid |
$164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.63
|
| Rate for Payer: Molina Healthcare Passport |
$164.34
|
| Rate for Payer: Multiplan PHCS |
$1,522.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.93
|
| Rate for Payer: UHCCP Medicaid |
$887.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.41
|
|
|
CT BRAIN/HEAD W/O CONTRAST
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$761.10 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
CT BRAIN/HEAD W/O CONTRAST(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
350P0022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$333.03 |
| Rate for Payer: Aetna Commercial |
$333.03
|
| Rate for Payer: Ambetter Exchange |
$98.41
|
| Rate for Payer: Anthem Medicaid |
$164.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.09
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$332.05
|
| Rate for Payer: Healthspan PPO |
$228.84
|
| Rate for Payer: Humana Medicaid |
$164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.63
|
| Rate for Payer: Molina Healthcare Passport |
$164.34
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.93
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.41
|
|
|
CT BRAIN/HEAD W/O CONTRAST(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
350T0022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$716.10 |
| Max. Negotiated Rate |
$2,291.52 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna Commercial |
$1,981.21
|
| Rate for Payer: First Health Commercial |
$2,267.65
|
| Rate for Payer: Humana Commercial |
$2,028.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,957.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,761.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$716.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,100.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,790.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.03
|
| Rate for Payer: PHCS Commercial |
$2,291.52
|
| Rate for Payer: United Healthcare All Payer |
$2,100.56
|
|
|
CT BRAIN/HEAD W/O CONTRAST(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
350T0022
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,291.52 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Anthem Medicaid |
$820.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna Commercial |
$1,981.21
|
| Rate for Payer: First Health Commercial |
$2,267.65
|
| Rate for Payer: Humana Commercial |
$2,028.95
|
| Rate for Payer: Humana KY Medicaid |
$820.89
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$829.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,957.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,761.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$837.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,100.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,790.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.03
|
| Rate for Payer: PHCS Commercial |
$2,291.52
|
| Rate for Payer: United Healthcare All Payer |
$2,100.56
|
|
|
CT BRAIN/HEAD W/WO CONTRAST
|
Facility
|
OP
|
$3,012.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
35000024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,891.52 |
| Rate for Payer: Aetna Commercial |
$2,319.24
|
| Rate for Payer: Anthem Medicaid |
$1,035.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,349.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,506.00
|
| Rate for Payer: Cash Price |
$1,506.00
|
| Rate for Payer: Cigna Commercial |
$2,499.96
|
| Rate for Payer: First Health Commercial |
$2,861.40
|
| Rate for Payer: Humana Commercial |
$2,560.20
|
| Rate for Payer: Humana KY Medicaid |
$1,035.83
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,046.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,469.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,222.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,056.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,650.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,620.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.28
|
| Rate for Payer: PHCS Commercial |
$2,891.52
|
| Rate for Payer: United Healthcare All Payer |
$2,650.56
|
|
|
CT BRAIN/HEAD W/WO CONTRAST
|
Professional
|
Both
|
$3,012.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
35000024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$1,807.20 |
| Rate for Payer: Aetna Commercial |
$520.31
|
| Rate for Payer: Ambetter Exchange |
$159.56
|
| Rate for Payer: Anthem Medicaid |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$191.47
|
| Rate for Payer: Cash Price |
$1,506.00
|
| Rate for Payer: Cash Price |
$1,506.00
|
| Rate for Payer: Cigna Commercial |
$504.69
|
| Rate for Payer: Healthspan PPO |
$357.53
|
| Rate for Payer: Humana Medicaid |
$245.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.61
|
| Rate for Payer: Molina Healthcare Passport |
$245.70
|
| Rate for Payer: Multiplan PHCS |
$1,807.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$207.43
|
| Rate for Payer: UHCCP Medicaid |
$1,054.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.56
|
|
|
CT BRAIN/HEAD W/WO CONTRAST
|
Facility
|
IP
|
$3,012.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
35000024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$903.60 |
| Max. Negotiated Rate |
$2,891.52 |
| Rate for Payer: Aetna Commercial |
$2,319.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,349.36
|
| Rate for Payer: Cash Price |
$1,506.00
|
| Rate for Payer: Cigna Commercial |
$2,499.96
|
| Rate for Payer: First Health Commercial |
$2,861.40
|
| Rate for Payer: Humana Commercial |
$2,560.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,469.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,222.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,650.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,259.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,620.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.28
|
| Rate for Payer: PHCS Commercial |
$2,891.52
|
| Rate for Payer: United Healthcare All Payer |
$2,650.56
|
|
|
CT BRAIN/HEAD W/WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
350P0024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$520.31 |
| Rate for Payer: Aetna Commercial |
$520.31
|
| Rate for Payer: Ambetter Exchange |
$159.56
|
| Rate for Payer: Anthem Medicaid |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$191.47
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$504.69
|
| Rate for Payer: Healthspan PPO |
$357.53
|
| Rate for Payer: Humana Medicaid |
$245.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.61
|
| Rate for Payer: Molina Healthcare Passport |
$245.70
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$207.43
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.56
|
|
|
CT BRAIN/HEAD W/WO CONTRAST(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
350T0024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem Medicaid |
$958.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Humana KY Medicaid |
$958.45
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$968.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$977.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
CT BRAIN/HEAD W/WO CONTRAST(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
350T0024
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$836.10 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$836.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
CT CALC SCORE W/O CONT
|
Facility
|
OP
|
$2,512.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$2,411.52 |
| Rate for Payer: Aetna Commercial |
$1,934.24
|
| Rate for Payer: Anthem Medicaid |
$863.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,959.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$2,084.96
|
| Rate for Payer: First Health Commercial |
$2,386.40
|
| Rate for Payer: Humana Commercial |
$2,135.20
|
| Rate for Payer: Humana KY Medicaid |
$863.88
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$872.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,059.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,853.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$881.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,210.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,884.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,185.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.28
|
| Rate for Payer: PHCS Commercial |
$2,411.52
|
| Rate for Payer: United Healthcare All Payer |
$2,210.56
|
|
