|
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
|
OP
|
$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 Medicaid |
$773.77
|
| 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: Humana KY Medicaid |
$773.77
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| 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: Molina Healthcare Medicaid |
$789.30
|
| 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
|
|
|
CT GUID/MONITR FOR PARENCHYMAL
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 77013
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$261.51 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna Commercial |
$875.14
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
|
|
CT HEAD ORBIT FACIAL W/O
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
351
|
| 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 HEAD ORBIT FACIAL W/O
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
351
|
| 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 HEAD ORBIT FACIAL W/O
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Aetna Commercial |
$394.97
|
| Rate for Payer: Ambetter Exchange |
$146.62
|
| Rate for Payer: Anthem Medicaid |
$182.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.94
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$408.61
|
| Rate for Payer: Healthspan PPO |
$271.40
|
| Rate for Payer: Humana Medicaid |
$182.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.44
|
| Rate for Payer: Molina Healthcare Passport |
$182.78
|
| Rate for Payer: Multiplan PHCS |
$1,582.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.61
|
| Rate for Payer: UHCCP Medicaid |
$922.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.62
|
|
|
CT HEAD ORBIT FACIAL W/O(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
350P0025
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$408.61 |
| Rate for Payer: Aetna Commercial |
$394.97
|
| Rate for Payer: Ambetter Exchange |
$146.62
|
| Rate for Payer: Anthem Medicaid |
$182.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.94
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$408.61
|
| Rate for Payer: Healthspan PPO |
$271.40
|
| Rate for Payer: Humana Medicaid |
$182.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$186.44
|
| Rate for Payer: Molina Healthcare Passport |
$182.78
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.61
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.62
|
|
|
CT HEAD ORBIT FACIAL W/O(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
350T0025
|
|
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 HEAD ORBIT FACIAL W/O(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70480
|
| Hospital Charge Code |
350T0025
|
|
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 HRT C+ STRUX CGEN HRT DS
|
Professional
|
Both
|
$2,182.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
35000094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$156.09 |
| Max. Negotiated Rate |
$1,309.20 |
| Rate for Payer: Aetna Commercial |
$566.42
|
| Rate for Payer: Ambetter Exchange |
$282.95
|
| Rate for Payer: Anthem Medicaid |
$272.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$282.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$282.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$339.54
|
| Rate for Payer: Cash Price |
$1,091.00
|
| Rate for Payer: Cash Price |
$1,091.00
|
| Rate for Payer: Cigna Commercial |
$581.88
|
| Rate for Payer: Healthspan PPO |
$305.83
|
| Rate for Payer: Humana Medicaid |
$272.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$156.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$282.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.81
|
| Rate for Payer: Molina Healthcare Passport |
$272.36
|
| Rate for Payer: Multiplan PHCS |
$1,309.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.83
|
| Rate for Payer: UHCCP Medicaid |
$763.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.95
|
|
|
CT HRT C+ STRUX CGEN HRT DS
|
Facility
|
OP
|
$2,182.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
35000094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,094.72 |
| Rate for Payer: Aetna Commercial |
$1,680.14
|
| Rate for Payer: Anthem Medicaid |
$750.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,091.00
|
| Rate for Payer: Cash Price |
$1,091.00
|
| Rate for Payer: Cigna Commercial |
$1,811.06
|
| Rate for Payer: First Health Commercial |
$2,072.90
|
| Rate for Payer: Humana Commercial |
$1,854.70
|
| Rate for Payer: Humana KY Medicaid |
$750.39
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$758.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,789.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,610.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,920.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,636.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,898.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,505.58
|
| Rate for Payer: PHCS Commercial |
$2,094.72
|
| Rate for Payer: United Healthcare All Payer |
$1,920.16
|
|
|
CT HRT C+ STRUX CGEN HRT DS
|
Facility
|
IP
|
$2,182.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
35000094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$654.60 |
| Max. Negotiated Rate |
$2,094.72 |
| Rate for Payer: Aetna Commercial |
$1,680.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.96
|
| Rate for Payer: Cash Price |
$1,091.00
|
| Rate for Payer: Cigna Commercial |
$1,811.06
|
| Rate for Payer: First Health Commercial |
$2,072.90
|
| Rate for Payer: Humana Commercial |
$1,854.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,789.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,610.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,920.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,636.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,898.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,505.58
|
| Rate for Payer: PHCS Commercial |
$2,094.72
|
| Rate for Payer: United Healthcare All Payer |
$1,920.16
|
|
|
CT HRT C+ STRUX CGEN HRT DS (P
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
350P0094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$581.88 |
| Rate for Payer: Aetna Commercial |
$566.42
|
| Rate for Payer: Ambetter Exchange |
$282.95
|
| Rate for Payer: Anthem Medicaid |
$272.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$282.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$282.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$339.54
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$581.88
|
| Rate for Payer: Healthspan PPO |
$305.83
|
| Rate for Payer: Humana Medicaid |
$272.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$156.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$282.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.81
|
| Rate for Payer: Molina Healthcare Passport |
$272.36
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.83
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.95
|
|
|
CT HRT C+ STRUX CGEN HRT DS (T
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
350T0094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$611.10 |
| Max. Negotiated Rate |
$1,955.52 |
| Rate for Payer: Aetna Commercial |
$1,568.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,588.86
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: Cigna Commercial |
$1,690.71
|
| Rate for Payer: First Health Commercial |
$1,935.15
|
| Rate for Payer: Humana Commercial |
$1,731.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.53
|
| Rate for Payer: PHCS Commercial |
$1,955.52
|
| Rate for Payer: United Healthcare All Payer |
$1,792.56
|
|
|
CT HRT C+ STRUX CGEN HRT DS (T
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
HCPCS 75573
|
| Hospital Charge Code |
350T0094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$1,955.52 |
| Rate for Payer: Aetna Commercial |
$1,568.49
|
| Rate for Payer: Anthem Medicaid |
$700.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,588.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: Cigna Commercial |
$1,690.71
|
| Rate for Payer: First Health Commercial |
$1,935.15
|
| Rate for Payer: Humana Commercial |
$1,731.45
|
| Rate for Payer: Humana KY Medicaid |
$700.52
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$707.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.53
|
| Rate for Payer: PHCS Commercial |
$1,955.52
|
| Rate for Payer: United Healthcare All Payer |
$1,792.56
|
|
|
CT HRT W/3D IMAGE
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 75572
|
| Hospital Charge Code |
35000012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$106.46 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna Commercial |
$398.64
|
| Rate for Payer: Ambetter Exchange |
$209.94
|
| Rate for Payer: Anthem Medicaid |
$191.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.93
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$409.47
|
| Rate for Payer: Healthspan PPO |
$215.12
|
| Rate for Payer: Humana Medicaid |
$191.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.39
|
| Rate for Payer: Molina Healthcare Passport |
$191.56
|
| Rate for Payer: Multiplan PHCS |
$1,812.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.92
|
| Rate for Payer: UHCCP Medicaid |
$1,057.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.94
|
|
|
CT HRT W/3D IMAGE
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 75572
|
| Hospital Charge Code |
35000012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem Medicaid |
$1,038.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Humana KY Medicaid |
$1,038.58
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,049.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,059.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,627.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,083.80
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
CT HRT W/3D IMAGE
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 75572
|
| Hospital Charge Code |
35000012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,627.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,083.80
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
CT HRT W/3D IMAGE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75572
|
| Hospital Charge Code |
350P0012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$409.47 |
| Rate for Payer: Aetna Commercial |
$398.64
|
| Rate for Payer: Ambetter Exchange |
$209.94
|
| Rate for Payer: Anthem Medicaid |
$191.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.93
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$409.47
|
| Rate for Payer: Healthspan PPO |
$215.12
|
| Rate for Payer: Humana Medicaid |
$191.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.39
|
| Rate for Payer: Molina Healthcare Passport |
$191.56
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.92
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.94
|
|
|
CT HRT W/3D IMAGE(T
|
Facility
|
OP
|
$2,895.00
|
|
|
Service Code
|
HCPCS 75572
|
| Hospital Charge Code |
350T0012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,779.20 |
| Rate for Payer: Aetna Commercial |
$2,229.15
|
| Rate for Payer: Anthem Medicaid |
$995.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,258.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,447.50
|
| Rate for Payer: Cash Price |
$1,447.50
|
| Rate for Payer: Cigna Commercial |
$2,402.85
|
| Rate for Payer: First Health Commercial |
$2,750.25
|
| Rate for Payer: Humana Commercial |
$2,460.75
|
| Rate for Payer: Humana KY Medicaid |
$995.59
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,005.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,373.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,136.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,015.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,547.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,171.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,518.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,997.55
|
| Rate for Payer: PHCS Commercial |
$2,779.20
|
| Rate for Payer: United Healthcare All Payer |
$2,547.60
|
|
|
CT HRT W/3D IMAGE(T
|
Facility
|
IP
|
$2,895.00
|
|
|
Service Code
|
HCPCS 75572
|
| Hospital Charge Code |
350T0012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$868.50 |
| Max. Negotiated Rate |
$2,779.20 |
| Rate for Payer: Aetna Commercial |
$2,229.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,258.10
|
| Rate for Payer: Cash Price |
$1,447.50
|
| Rate for Payer: Cigna Commercial |
$2,402.85
|
| Rate for Payer: First Health Commercial |
$2,750.25
|
| Rate for Payer: Humana Commercial |
$2,460.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,373.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,136.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$868.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,547.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,171.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,518.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,997.55
|
| Rate for Payer: PHCS Commercial |
$2,779.20
|
| Rate for Payer: United Healthcare All Payer |
$2,547.60
|
|
|
CT INJ OF SINUS TRACT SINOGRAM
|
Facility
|
IP
|
$1,139.00
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.70 |
| Max. Negotiated Rate |
$1,093.44 |
| Rate for Payer: Aetna Commercial |
$877.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$888.42
|
| Rate for Payer: Cash Price |
$569.50
|
| Rate for Payer: Cigna Commercial |
$945.37
|
| Rate for Payer: First Health Commercial |
$1,082.05
|
| Rate for Payer: Humana Commercial |
$968.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$840.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,002.32
|
| Rate for Payer: Ohio Health Group HMO |
$854.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$785.91
|
| Rate for Payer: PHCS Commercial |
$1,093.44
|
| Rate for Payer: United Healthcare All Payer |
$1,002.32
|
|
|
CT INJ OF SINUS TRACT SINOGRAM
|
Professional
|
Both
|
$1,139.00
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$683.40 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Ambetter Exchange |
$33.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.40
|
| Rate for Payer: Anthem Medicaid |
$30.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.75
|
| Rate for Payer: Cash Price |
$569.50
|
| Rate for Payer: Cash Price |
$569.50
|
| Rate for Payer: Cigna Commercial |
$62.92
|
| Rate for Payer: Healthspan PPO |
$164.01
|
| Rate for Payer: Humana Medicaid |
$30.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.45
|
| Rate for Payer: Molina Healthcare Passport |
$30.83
|
| Rate for Payer: Multiplan PHCS |
$683.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.15
|
| Rate for Payer: UHCCP Medicaid |
$30.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.96
|
|
|
CT INJ OF SINUS TRACT SINOGRAM
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
761T0332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$517.44 |
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.42
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna Commercial |
$447.37
|
| Rate for Payer: First Health Commercial |
$512.05
|
| Rate for Payer: Humana Commercial |
$458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$441.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$397.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.32
|
| Rate for Payer: Ohio Health Group HMO |
$404.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.91
|
| Rate for Payer: PHCS Commercial |
$517.44
|
| Rate for Payer: United Healthcare All Payer |
$474.32
|
|
|
CT INJ OF SINUS TRACT SINOGRAM
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
HCPCS 20501
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.70 |
| Max. Negotiated Rate |
$1,093.44 |
| Rate for Payer: Aetna Commercial |
$877.03
|
| Rate for Payer: Anthem Medicaid |
$391.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$888.42
|
| Rate for Payer: Cash Price |
$569.50
|
| Rate for Payer: Cigna Commercial |
$945.37
|
| Rate for Payer: First Health Commercial |
$1,082.05
|
| Rate for Payer: Humana Commercial |
$968.15
|
| Rate for Payer: Humana KY Medicaid |
$391.70
|
| Rate for Payer: Kentucky WC Medicaid |
$395.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$840.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,002.32
|
| Rate for Payer: Ohio Health Group HMO |
$854.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$785.91
|
| Rate for Payer: PHCS Commercial |
$1,093.44
|
| Rate for Payer: United Healthcare All Payer |
$1,002.32
|
|
