|
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
|
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
|
|
|
CT INNER EAR W/CONTRAST
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
35000026
|
|
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 INNER EAR W/CONTRAST
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
35000026
|
|
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 INNER EAR W/CONTRAST
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
35000026
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$87.85 |
| Max. Negotiated Rate |
$1,702.20 |
| Rate for Payer: Aetna Commercial |
$572.89
|
| Rate for Payer: Ambetter Exchange |
$165.31
|
| Rate for Payer: Anthem Medicaid |
$212.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.37
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$476.86
|
| Rate for Payer: Healthspan PPO |
$393.66
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$216.36
|
| Rate for Payer: Molina Healthcare Passport |
$212.12
|
| Rate for Payer: Multiplan PHCS |
$1,702.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.90
|
| Rate for Payer: UHCCP Medicaid |
$992.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$214.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.31
|
|
|
CT INNER EAR W/CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
350P0026
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$572.89 |
| Rate for Payer: Aetna Commercial |
$572.89
|
| Rate for Payer: Ambetter Exchange |
$165.31
|
| Rate for Payer: Anthem Medicaid |
$212.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.37
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$476.86
|
| Rate for Payer: Healthspan PPO |
$393.66
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$216.36
|
| Rate for Payer: Molina Healthcare Passport |
$212.12
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.90
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$214.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.31
|
|
|
CT INNER EAR W/CONTRAST(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
350T0026
|
|
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 INNER EAR W/CONTRAST(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70481
|
| Hospital Charge Code |
350T0026
|
|
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
|
|
|
C-TIP SWAN GANZ CATH 7FR
|
Facility
|
OP
|
$1,956.22
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.87 |
| Max. Negotiated Rate |
$1,877.97 |
| Rate for Payer: Aetna Commercial |
$1,506.29
|
| Rate for Payer: Anthem Medicaid |
$672.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,525.85
|
| Rate for Payer: Cash Price |
$978.11
|
| Rate for Payer: Cigna Commercial |
$1,623.66
|
| Rate for Payer: First Health Commercial |
$1,858.41
|
| Rate for Payer: Humana Commercial |
$1,662.79
|
| Rate for Payer: Humana KY Medicaid |
$672.74
|
| Rate for Payer: Kentucky WC Medicaid |
$679.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,604.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$686.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,721.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,467.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,701.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,349.79
|
| Rate for Payer: PHCS Commercial |
$1,877.97
|
| Rate for Payer: United Healthcare All Payer |
$1,721.47
|
|
|
C-TIP SWAN GANZ CATH 7FR
|
Facility
|
IP
|
$1,956.22
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.87 |
| Max. Negotiated Rate |
$1,877.97 |
| Rate for Payer: Aetna Commercial |
$1,506.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,525.85
|
| Rate for Payer: Cash Price |
$978.11
|
| Rate for Payer: Cigna Commercial |
$1,623.66
|
| Rate for Payer: First Health Commercial |
$1,858.41
|
| Rate for Payer: Humana Commercial |
$1,662.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,604.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,721.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,467.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,701.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,349.79
|
| Rate for Payer: PHCS Commercial |
$1,877.97
|
| Rate for Payer: United Healthcare All Payer |
$1,721.47
|
|
|
CT LOWER EXTREMITY W/CONTRAS(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
350P0056
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$495.07 |
| Rate for Payer: Aetna Commercial |
$495.07
|
| Rate for Payer: Ambetter Exchange |
$153.02
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$153.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$153.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.62
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$445.74
|
| Rate for Payer: Healthspan PPO |
$340.19
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$153.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.93
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$153.02
|
|
|
CT LOWER EXTREMITY W/CONTRAS(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
350T0056
|
|
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 LOWER EXTREMITY W/CONTRAS(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
350T0056
|
|
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 LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
35000056
|
|
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 LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
35000056
|
|
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 LOWER EXTREMITY W/CONTRAST
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
35000056
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Aetna Commercial |
$495.07
|
| Rate for Payer: Ambetter Exchange |
$153.02
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$153.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$153.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.62
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$445.74
|
| Rate for Payer: Healthspan PPO |
$340.19
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$153.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,687.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.93
|
| Rate for Payer: UHCCP Medicaid |
$984.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$153.02
|
|
|
CT LOWER EXTREMITY W/O DYE
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
35000055
|
|
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 LOWER EXTREMITY W/O DYE
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
35000055
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$1,552.20 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Ambetter Exchange |
$119.47
|
| Rate for Payer: Anthem Medicaid |
$180.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.36
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$378.15
|
| Rate for Payer: Healthspan PPO |
$261.42
|
| Rate for Payer: Humana Medicaid |
$180.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.33
|
| Rate for Payer: Molina Healthcare Passport |
$180.72
|
| Rate for Payer: Multiplan PHCS |
$1,552.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.31
|
| Rate for Payer: UHCCP Medicaid |
$905.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.47
|
|
|
CT LOWER EXTREMITY W/O DYE
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
35000055
|
|
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 LOWER EXTREMITY W/O DYE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
350P0055
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$380.43 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Ambetter Exchange |
$119.47
|
| Rate for Payer: Anthem Medicaid |
$180.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.36
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$378.15
|
| Rate for Payer: Healthspan PPO |
$261.42
|
| Rate for Payer: Humana Medicaid |
$180.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.33
|
| Rate for Payer: Molina Healthcare Passport |
$180.72
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.31
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.47
|
|
|
CT LOWER EXTREMITY W/O DYE(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
350T0055
|
|
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 LOWER EXTREMITY W/O DYE(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
350T0055
|
|
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 LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
35000047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,699.52 |
| Rate for Payer: Aetna Commercial |
$2,165.24
|
| Rate for Payer: Anthem Medicaid |
$967.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,193.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$2,333.96
|
| Rate for Payer: First Health Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial |
$2,390.20
|
| Rate for Payer: Humana KY Medicaid |
$967.05
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$976.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,075.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$986.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,474.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,109.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,446.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,940.28
|
| Rate for Payer: PHCS Commercial |
$2,699.52
|
| Rate for Payer: United Healthcare All Payer |
$2,474.56
|
|
|
CT LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
35000047
|
|
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 LUMBAR SPINE W CONTRAST
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
35000047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$1,687.20 |
| Rate for Payer: Aetna Commercial |
$518.86
|
| Rate for Payer: Ambetter Exchange |
$155.55
|
| Rate for Payer: Anthem Medicaid |
$243.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$155.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.66
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cash Price |
$1,406.00
|
| Rate for Payer: Cigna Commercial |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.53
|
| Rate for Payer: Humana Medicaid |
$243.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$155.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.05
|
| Rate for Payer: Molina Healthcare Passport |
$243.19
|
| Rate for Payer: Multiplan PHCS |
$1,687.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$202.22
|
| Rate for Payer: UHCCP Medicaid |
$984.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$155.55
|
|
