|
CT CALC SCORE W/O CONT
|
Professional
|
Both
|
$2,512.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$111.45
|
| Rate for Payer: Ambetter Exchange |
$92.04
|
| Rate for Payer: Anthem Medicaid |
$65.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.45
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$139.61
|
| Rate for Payer: Healthspan PPO |
$69.71
|
| Rate for Payer: Humana Medicaid |
$65.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.53
|
| Rate for Payer: Molina Healthcare Passport |
$65.23
|
| Rate for Payer: Multiplan PHCS |
$1,507.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.65
|
| Rate for Payer: UHCCP Medicaid |
$879.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.04
|
|
|
CT CALC SCORE W/O CONT
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
35000065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$753.60 |
| Max. Negotiated Rate |
$2,411.52 |
| Rate for Payer: Aetna Commercial |
$1,934.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,959.36
|
| 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: 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 |
$753.60
|
| 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
|
|
|
CT CALC SCORE W/O CONT(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
350P0065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$139.61 |
| Rate for Payer: Aetna Commercial |
$111.45
|
| Rate for Payer: Ambetter Exchange |
$92.04
|
| Rate for Payer: Anthem Medicaid |
$65.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.45
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$139.61
|
| Rate for Payer: Healthspan PPO |
$69.71
|
| Rate for Payer: Humana Medicaid |
$65.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.53
|
| Rate for Payer: Molina Healthcare Passport |
$65.23
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.65
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.04
|
|
|
CT CALC SCORE W/O CONT(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
350T0065
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$81.36 |
| 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 |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| 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 |
$81.36
|
| 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 |
$97.63
|
| 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 CALC SCORE W/O CONT(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 75571
|
| Hospital Charge Code |
350T0065
|
|
Hospital Revenue Code
|
352
|
| 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 CAROT ART ANGIOGRAM W/DYE
|
Facility
|
IP
|
$3,556.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
35000032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,066.80 |
| Max. Negotiated Rate |
$3,413.76 |
| Rate for Payer: Aetna Commercial |
$2,738.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,773.68
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cigna Commercial |
$2,951.48
|
| Rate for Payer: First Health Commercial |
$3,378.20
|
| Rate for Payer: Humana Commercial |
$3,022.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,915.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,624.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,129.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,667.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,093.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,453.64
|
| Rate for Payer: PHCS Commercial |
$3,413.76
|
| Rate for Payer: United Healthcare All Payer |
$3,129.28
|
|
|
CT CAROT ART ANGIOGRAM W/DYE
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
35000032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$111.63 |
| Max. Negotiated Rate |
$2,133.60 |
| Rate for Payer: Aetna Commercial |
$671.48
|
| Rate for Payer: Ambetter Exchange |
$253.30
|
| Rate for Payer: Anthem Medicaid |
$262.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$253.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$253.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.96
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cigna Commercial |
$816.62
|
| Rate for Payer: Healthspan PPO |
$461.41
|
| Rate for Payer: Humana Medicaid |
$262.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$253.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$268.13
|
| Rate for Payer: Molina Healthcare Passport |
$262.87
|
| Rate for Payer: Multiplan PHCS |
$2,133.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.29
|
| Rate for Payer: UHCCP Medicaid |
$1,244.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$265.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$253.30
|
|
|
CT CAROT ART ANGIOGRAM W/DYE
|
Facility
|
OP
|
$3,556.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
35000032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,413.76 |
| Rate for Payer: Aetna Commercial |
$2,738.12
|
| Rate for Payer: Anthem Medicaid |
$1,222.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,773.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cigna Commercial |
$2,951.48
|
| Rate for Payer: First Health Commercial |
$3,378.20
|
| Rate for Payer: Humana Commercial |
$3,022.60
|
| Rate for Payer: Humana KY Medicaid |
$1,222.91
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,235.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,915.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,624.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,247.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,129.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,667.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,093.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,453.64
|
| Rate for Payer: PHCS Commercial |
$3,413.76
|
| Rate for Payer: United Healthcare All Payer |
$3,129.28
|
|
|
CT CAROT ART ANGIOGRAM W/DYE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
350P0032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$816.62 |
| Rate for Payer: Aetna Commercial |
$671.48
|
| Rate for Payer: Ambetter Exchange |
$253.30
|
| Rate for Payer: Anthem Medicaid |
$262.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$253.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$253.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.96
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$816.62
|
| Rate for Payer: Healthspan PPO |
$461.41
|
| Rate for Payer: Humana Medicaid |
$262.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$253.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$268.13
|
| Rate for Payer: Molina Healthcare Passport |
$262.87
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.29
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$265.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$253.30
|
|
|
CT CAROT ART ANGIOGRAM W/DYE(T
|
Facility
|
IP
|
$3,331.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
350T0032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$3,197.76 |
| Rate for Payer: Aetna Commercial |
$2,564.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.18
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cigna Commercial |
$2,764.73
|
| Rate for Payer: First Health Commercial |
$3,164.45
|
| Rate for Payer: Humana Commercial |
$2,831.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.39
|
| Rate for Payer: PHCS Commercial |
$3,197.76
|
| Rate for Payer: United Healthcare All Payer |
$2,931.28
|
|
|
CT CAROT ART ANGIOGRAM W/DYE(T
|
Facility
|
OP
|
$3,331.00
|
|
|
Service Code
|
HCPCS 70498
|
| Hospital Charge Code |
350T0032
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,197.76 |
| Rate for Payer: Aetna Commercial |
$2,564.87
|
| Rate for Payer: Anthem Medicaid |
$1,145.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cigna Commercial |
$2,764.73
|
| Rate for Payer: First Health Commercial |
$3,164.45
|
| Rate for Payer: Humana Commercial |
$2,831.35
|
| Rate for Payer: Humana KY Medicaid |
$1,145.53
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,157.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,168.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.39
|
| Rate for Payer: PHCS Commercial |
$3,197.76
|
| Rate for Payer: United Healthcare All Payer |
$2,931.28
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Aetna Commercial |
$518.86
|
| Rate for Payer: Ambetter Exchange |
$154.96
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$154.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.95
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.53
|
| Rate for Payer: Humana Medicaid |
$243.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$154.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.05
|
| Rate for Payer: Molina Healthcare Passport |
$243.19
|
| Rate for Payer: Multiplan PHCS |
$1,687.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.45
|
| Rate for Payer: UHCCP Medicaid |
$984.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.96
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,699.52 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem Medicaid |
$967.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,193.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Humana KY Medicaid |
$967.05
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$976.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$986.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$843.60 |
| Max. Negotiated Rate |
$2,699.52 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,193.36
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
CT CERVICAL SPINE W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
350P0041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$518.86 |
| Rate for Payer: Aetna Commercial |
$518.86
|
| Rate for Payer: Ambetter Exchange |
$154.96
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$154.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.95
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.53
|
| Rate for Payer: Humana Medicaid |
$243.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$154.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.05
|
| Rate for Payer: Molina Healthcare Passport |
$243.19
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.45
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.96
|
|
|
CT CERVICAL SPINE W/CONTRAST(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
350T0041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem Medicaid |
$889.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Humana KY Medicaid |
$889.67
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$898.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$907.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
CT CERVICAL SPINE W/CONTRAST(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72126
|
| Hospital Charge Code |
350T0041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$776.10 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
350T0040
|
|
Hospital Revenue Code
|
352
|
| 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 CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$776.10 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
350T0040
|
|
Hospital Revenue Code
|
352
|
| 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 CERVICAL SPINE W/O CONTRAST
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
350P0040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$425.87 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Ambetter Exchange |
$119.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.72
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.70
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.77
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem Medicaid |
$889.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Humana KY Medicaid |
$889.67
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$898.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$907.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72125
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$1,552.20 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Ambetter Exchange |
$119.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.72
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$119.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,552.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.70
|
| Rate for Payer: UHCCP Medicaid |
$905.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.77
|
|
|
CT CERVICAL SPINE W/O&W/CONT
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$911.10 |
| Max. Negotiated Rate |
$2,915.52 |
| Rate for Payer: Aetna Commercial |
$2,338.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.86
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$2,520.71
|
| Rate for Payer: First Health Commercial |
$2,885.15
|
| Rate for Payer: Humana Commercial |
$2,581.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,672.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.53
|
| Rate for Payer: PHCS Commercial |
$2,915.52
|
| Rate for Payer: United Healthcare All Payer |
$2,672.56
|
|
|
CT CERVICAL SPINE W/O&W/CONT
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,915.52 |
| Rate for Payer: Aetna Commercial |
$2,338.49
|
| Rate for Payer: Anthem Medicaid |
$1,044.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$2,520.71
|
| Rate for Payer: First Health Commercial |
$2,885.15
|
| Rate for Payer: Humana Commercial |
$2,581.45
|
| Rate for Payer: Humana KY Medicaid |
$1,044.42
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,672.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.53
|
| Rate for Payer: PHCS Commercial |
$2,915.52
|
| Rate for Payer: United Healthcare All Payer |
$2,672.56
|
|
