|
CT DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$5,039.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
350T0092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,511.70 |
| Max. Negotiated Rate |
$4,837.44 |
| Rate for Payer: Aetna Commercial |
$3,880.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,930.42
|
| Rate for Payer: Cash Price |
$2,519.50
|
| Rate for Payer: Cigna Commercial |
$4,182.37
|
| Rate for Payer: First Health Commercial |
$4,787.05
|
| Rate for Payer: Humana Commercial |
$4,283.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,434.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,779.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,383.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,476.91
|
| Rate for Payer: PHCS Commercial |
$4,837.44
|
| Rate for Payer: United Healthcare All Payer |
$4,434.32
|
|
|
CT DRAIN BL W/CATH INSERT (P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
350P0092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.02 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$249.66
|
| Rate for Payer: Ambetter Exchange |
$132.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$96.02
|
| Rate for Payer: Anthem Medicaid |
$275.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.58
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$368.54
|
| Rate for Payer: Healthspan PPO |
$299.76
|
| Rate for Payer: Humana Medicaid |
$275.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$281.45
|
| Rate for Payer: Molina Healthcare Passport |
$275.93
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.87
|
| Rate for Payer: UHCCP Medicaid |
$100.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.98
|
|
|
CT FACIAL BONES W/CONTRAST
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,723.52 |
| Rate for Payer: Aetna Commercial |
$2,184.49
|
| Rate for Payer: Anthem Medicaid |
$975.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,212.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$2,354.71
|
| Rate for Payer: First Health Commercial |
$2,695.15
|
| Rate for Payer: Humana Commercial |
$2,411.45
|
| Rate for Payer: Humana KY Medicaid |
$975.64
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$985.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,326.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,093.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$995.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,496.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,127.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,468.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,957.53
|
| Rate for Payer: PHCS Commercial |
$2,723.52
|
| Rate for Payer: United Healthcare All Payer |
$2,496.56
|
|
|
CT FACIAL BONES W/CONTRAST
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$1,702.20 |
| Rate for Payer: Aetna Commercial |
$515.45
|
| Rate for Payer: Ambetter Exchange |
$139.96
|
| Rate for Payer: Anthem Medicaid |
$208.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.95
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$450.67
|
| Rate for Payer: Healthspan PPO |
$354.19
|
| Rate for Payer: Humana Medicaid |
$208.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.87
|
| Rate for Payer: Molina Healthcare Passport |
$208.70
|
| Rate for Payer: Multiplan PHCS |
$1,702.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.95
|
| Rate for Payer: UHCCP Medicaid |
$992.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.96
|
|
|
CT FACIAL BONES W/CONTRAST
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$851.10 |
| Max. Negotiated Rate |
$2,723.52 |
| Rate for Payer: Aetna Commercial |
$2,184.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,212.86
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$2,354.71
|
| Rate for Payer: First Health Commercial |
$2,695.15
|
| Rate for Payer: Humana Commercial |
$2,411.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,326.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,093.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$851.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,496.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,127.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,468.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,957.53
|
| Rate for Payer: PHCS Commercial |
$2,723.52
|
| Rate for Payer: United Healthcare All Payer |
$2,496.56
|
|
|
CT FACIAL BONES W/CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
350P0029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$515.45
|
| Rate for Payer: Ambetter Exchange |
$139.96
|
| Rate for Payer: Anthem Medicaid |
$208.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.95
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$450.67
|
| Rate for Payer: Healthspan PPO |
$354.19
|
| Rate for Payer: Humana Medicaid |
$208.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.87
|
| Rate for Payer: Molina Healthcare Passport |
$208.70
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.95
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.96
|
|
|
CT FACIAL BONES W/CONTRAST(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
350T0029
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/CONTRAST(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
350T0029
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/O CONTRAST
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/O CONTRAST
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/O CONTRAST
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$1,552.20 |
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Ambetter Exchange |
$117.57
|
| Rate for Payer: Anthem Medicaid |
$176.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.08
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$376.69
|
| Rate for Payer: Healthspan PPO |
$264.01
|
| Rate for Payer: Humana Medicaid |
$176.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.08
|
| Rate for Payer: Molina Healthcare Passport |
$176.55
|
| Rate for Payer: Multiplan PHCS |
$1,552.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.84
|
| Rate for Payer: UHCCP Medicaid |
$905.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.57
|
|
|
CT FACIAL BONES W/O CONTRAST(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
350P0028
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$384.21 |
| Rate for Payer: Aetna Commercial |
$384.21
|
| Rate for Payer: Ambetter Exchange |
$117.57
|
| Rate for Payer: Anthem Medicaid |
$176.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.08
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$376.69
|
| Rate for Payer: Healthspan PPO |
$264.01
|
| Rate for Payer: Humana Medicaid |
$176.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.08
|
| Rate for Payer: Molina Healthcare Passport |
$176.55
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.84
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.57
|
|
|
CT FACIAL BONES W/O CONTRAST(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
350T0028
|
|
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 FACIAL BONES W/O CONTRAST(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
350T0028
|
|
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 FACIAL BONES W/WO CONTRA
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$90.01 |
| Max. Negotiated Rate |
$1,822.20 |
| Rate for Payer: Aetna Commercial |
$626.38
|
| Rate for Payer: Ambetter Exchange |
$168.99
|
| Rate for Payer: Anthem Medicaid |
$252.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.79
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$547.15
|
| Rate for Payer: Healthspan PPO |
$430.42
|
| Rate for Payer: Humana Medicaid |
$252.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.26
|
| Rate for Payer: Molina Healthcare Passport |
$252.22
|
| Rate for Payer: Multiplan PHCS |
$1,822.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.69
|
| Rate for Payer: UHCCP Medicaid |
$1,062.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.99
|
|
|
CT FACIAL BONES W/WO CONTRA
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/WO CONTRA
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
351
|
| 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 FACIAL BONES W/WO CONTRA(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
350P0030
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$626.38 |
| Rate for Payer: Aetna Commercial |
$626.38
|
| Rate for Payer: Ambetter Exchange |
$168.99
|
| Rate for Payer: Anthem Medicaid |
$252.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.79
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$547.15
|
| Rate for Payer: Healthspan PPO |
$430.42
|
| Rate for Payer: Humana Medicaid |
$252.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.26
|
| Rate for Payer: Molina Healthcare Passport |
$252.22
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.69
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$254.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.99
|
|
|
CT FACIAL BONES W/WO CONTRA(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
350T0030
|
|
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 FACIAL BONES W/WO CONTRA(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70488
|
| Hospital Charge Code |
350T0030
|
|
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 FUSION/UNLISTED PROC
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 77399
|
| Hospital Charge Code |
33300024
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$129.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$129.99
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$131.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
CT FUSION/UNLISTED PROC
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 77399
|
| Hospital Charge Code |
33300024
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
350P0018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$875.14 |
| Rate for Payer: Aetna Commercial |
$875.14
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$826.15
|
| Rate for Payer: Healthspan PPO |
$709.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$261.51
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
350T0018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
