|
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
|
|
|
CT CERVICAL SPINE W/O&W/CONT(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
350P0042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$616.44
|
| Rate for Payer: Ambetter Exchange |
$180.19
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$216.23
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$609.61
|
| Rate for Payer: Healthspan PPO |
$423.59
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.19
|
| 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 |
$234.25
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.19
|
|
|
CT CERVICAL SPINE W/O&W/CONT(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
350T0042
|
|
Hospital Revenue Code
|
352
|
| 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 CERVICAL SPINE W/O&W/CONT(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 72127
|
| Hospital Charge Code |
350T0042
|
|
Hospital Revenue Code
|
352
|
| 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 CHEST W/CONTRAST
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
35000038
|
|
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 CHEST W/CONTRAST
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
35000038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$79.16 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Aetna Commercial |
$520.01
|
| Rate for Payer: Ambetter Exchange |
$153.31
|
| Rate for Payer: Anthem Medicaid |
$244.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$153.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$153.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.97
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$503.50
|
| Rate for Payer: Healthspan PPO |
$357.32
|
| Rate for Payer: Humana Medicaid |
$244.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$153.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.20
|
| Rate for Payer: Molina Healthcare Passport |
$244.31
|
| Rate for Payer: Multiplan PHCS |
$1,687.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.30
|
| Rate for Payer: UHCCP Medicaid |
$984.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$153.31
|
|
|
CT CHEST W/CONTRAST
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
35000038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| 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 |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,193.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,406.00
|
| 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 |
$164.49
|
| 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 |
$197.39
|
| 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 CHEST W/CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
350P0038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$520.01 |
| Rate for Payer: Aetna Commercial |
$520.01
|
| Rate for Payer: Ambetter Exchange |
$153.31
|
| Rate for Payer: Anthem Medicaid |
$244.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$153.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$153.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.97
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$503.50
|
| Rate for Payer: Healthspan PPO |
$357.32
|
| Rate for Payer: Humana Medicaid |
$244.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$153.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.20
|
| Rate for Payer: Molina Healthcare Passport |
$244.31
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.30
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$153.31
|
|
|
CT CHEST W/CONTRAST(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
350T0038
|
|
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 CHEST W/CONTRAST(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 71260
|
| Hospital Charge Code |
350T0038
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| 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 |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,293.50
|
| 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 |
$164.49
|
| 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 |
$197.39
|
| 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 CHEST W/O CONTRAST
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
35000037
|
|
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 CHEST W/O CONTRAST
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
35000037
|
|
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 CHEST W/O CONTRAST
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
35000037
|
|
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 |
$122.69
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.23
|
| 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 |
$122.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.69
|
| 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 |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$905.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.69
|
|
|
CT CHEST W/O CONTRAST(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
350P0037
|
|
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 |
$122.69
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.23
|
| 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 |
$122.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.69
|
| 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 |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.69
|
|
|
CT CHEST W/O CONTRAST(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
350T0037
|
|
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 CHEST W/O CONTRAST(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
350T0037
|
|
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 CHEST W/WO CONTRAST
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
35000039
|
|
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 CHEST W/WO CONTRAST
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
35000039
|
|
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
|
|
|
CT CHEST W/WO CONTRAST
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
35000039
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$1,822.20 |
| Rate for Payer: Aetna Commercial |
$625.47
|
| Rate for Payer: Ambetter Exchange |
$179.84
|
| Rate for Payer: Anthem Medicaid |
$297.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$179.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$179.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$215.81
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$618.82
|
| Rate for Payer: Healthspan PPO |
$429.79
|
| Rate for Payer: Humana Medicaid |
$297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$179.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.75
|
| Rate for Payer: Molina Healthcare Passport |
$297.79
|
| Rate for Payer: Multiplan PHCS |
$1,822.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$233.79
|
| Rate for Payer: UHCCP Medicaid |
$1,062.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$179.84
|
|
|
CT CHEST W/WO CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
350P0039
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$625.47 |
| Rate for Payer: Aetna Commercial |
$625.47
|
| Rate for Payer: Ambetter Exchange |
$179.84
|
| Rate for Payer: Anthem Medicaid |
$297.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$179.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$179.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$215.81
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$618.82
|
| Rate for Payer: Healthspan PPO |
$429.79
|
| Rate for Payer: Humana Medicaid |
$297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$179.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.75
|
| Rate for Payer: Molina Healthcare Passport |
$297.79
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$233.79
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$179.84
|
|
|
CT CHEST W/WO CONTRAST(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
350T0039
|
|
Hospital Revenue Code
|
352
|
| 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 CHEST W/WO CONTRAST(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 71270
|
| Hospital Charge Code |
350T0039
|
|
Hospital Revenue Code
|
352
|
| 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 COLONOGRAPHY DX
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,531.52 |
| Rate for Payer: Aetna Commercial |
$2,030.49
|
| Rate for Payer: Anthem Medicaid |
$906.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,056.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$2,188.71
|
| Rate for Payer: First Health Commercial |
$2,505.15
|
| Rate for Payer: Humana Commercial |
$2,241.45
|
| Rate for Payer: Humana KY Medicaid |
$906.86
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$916.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,162.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,946.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$925.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,320.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,977.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,819.53
|
| Rate for Payer: PHCS Commercial |
$2,531.52
|
| Rate for Payer: United Healthcare All Payer |
$2,320.56
|
|
|
CT COLONOGRAPHY DX
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$791.10 |
| Max. Negotiated Rate |
$2,531.52 |
| Rate for Payer: Aetna Commercial |
$2,030.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,056.86
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$2,188.71
|
| Rate for Payer: First Health Commercial |
$2,505.15
|
| Rate for Payer: Humana Commercial |
$2,241.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,162.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,946.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$791.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,320.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,977.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,819.53
|
| Rate for Payer: PHCS Commercial |
$2,531.52
|
| Rate for Payer: United Healthcare All Payer |
$2,320.56
|
|
|
CT COLONOGRAPHY DX
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$147.96 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Aetna Commercial |
$464.72
|
| Rate for Payer: Ambetter Exchange |
$375.89
|
| Rate for Payer: Anthem Medicaid |
$296.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$451.07
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$634.38
|
| Rate for Payer: Healthspan PPO |
$399.18
|
| Rate for Payer: Humana Medicaid |
$296.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$375.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.97
|
| Rate for Payer: Molina Healthcare Passport |
$296.05
|
| Rate for Payer: Multiplan PHCS |
$1,582.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.66
|
| Rate for Payer: UHCCP Medicaid |
$922.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.89
|
|
