|
CT LUMBAR SPINE W CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
350P0047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$518.86 |
| 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 |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$501.76
|
| Rate for Payer: Healthspan PPO |
$356.53
|
| Rate for Payer: Humana Medicaid |
$243.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.88
|
| 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 |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$202.22
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$155.55
|
|
|
CT LUMBAR SPINE W CONTRAST(T
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
350T0047
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$2,483.52 |
| Rate for Payer: Aetna Commercial |
$1,991.99
|
| Rate for Payer: Anthem Medicaid |
$889.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,017.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cash Price |
$1,293.50
|
| Rate for Payer: Cigna Commercial |
$2,147.21
|
| Rate for Payer: First Health Commercial |
$2,457.65
|
| Rate for Payer: Humana Commercial |
$2,198.95
|
| Rate for Payer: Humana KY Medicaid |
$889.67
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$898.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,121.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$907.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,276.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,940.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,069.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,250.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.03
|
| Rate for Payer: PHCS Commercial |
$2,483.52
|
| Rate for Payer: United Healthcare All Payer |
$2,276.56
|
|
|
CT LUMBAR SPINE W CONTRAST(T
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
350T0047
|
|
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 LUMBAR SPINE W/O CONTRAST
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
35000046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$1,567.20 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Ambetter Exchange |
$119.18
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.02
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cigna Commercial |
$425.87
|
| Rate for Payer: Healthspan PPO |
$265.77
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.93
|
| Rate for Payer: UHCCP Medicaid |
$914.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.18
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
35000046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$783.60 |
| Max. Negotiated Rate |
$2,507.52 |
| Rate for Payer: Aetna Commercial |
$2,011.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,037.36
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cigna Commercial |
$2,167.96
|
| Rate for Payer: First Health Commercial |
$2,481.40
|
| Rate for Payer: Humana Commercial |
$2,220.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,141.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,927.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$783.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,298.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,959.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,272.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,802.28
|
| Rate for Payer: PHCS Commercial |
$2,507.52
|
| Rate for Payer: United Healthcare All Payer |
$2,298.56
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
35000046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,507.52 |
| Rate for Payer: Aetna Commercial |
$2,011.24
|
| Rate for Payer: Anthem Medicaid |
$898.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,037.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cash Price |
$1,306.00
|
| Rate for Payer: Cigna Commercial |
$2,167.96
|
| Rate for Payer: First Health Commercial |
$2,481.40
|
| Rate for Payer: Humana Commercial |
$2,220.20
|
| Rate for Payer: Humana KY Medicaid |
$898.27
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$907.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,141.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,927.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$916.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,298.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,959.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,272.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,802.28
|
| Rate for Payer: PHCS Commercial |
$2,507.52
|
| Rate for Payer: United Healthcare All Payer |
$2,298.56
|
|
|
CT LUMBAR SPINE W/O CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
350P0046
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$425.87 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Ambetter Exchange |
$119.18
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.02
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$425.87
|
| Rate for Payer: Healthspan PPO |
$265.77
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.18
|
| 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 |
$154.93
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.18
|
|
|
CT LUMBAR SPINE W/O CONTRAST(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
350T0046
|
|
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 LUMBAR SPINE W/O CONTRAST(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
350T0046
|
|
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 WO CONTRAS(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
350P0048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$616.99 |
| Rate for Payer: Aetna Commercial |
$616.99
|
| Rate for Payer: Ambetter Exchange |
$180.48
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$216.58
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$611.81
|
| Rate for Payer: Healthspan PPO |
$423.96
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.08
|
| Rate for Payer: Molina Healthcare Passport |
$293.22
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.62
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.48
|
|
|
CT LUMBAR SPINE W WO CONTRAS(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
350T0048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem Medicaid |
$958.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Humana KY Medicaid |
$958.45
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$968.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$977.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
CT LUMBAR SPINE W WO CONTRAS(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
350T0048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$836.10 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$836.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
35000048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,915.52 |
| Rate for Payer: Aetna Commercial |
$2,338.49
|
| Rate for Payer: Anthem Medicaid |
$1,044.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$2,520.71
|
| Rate for Payer: First Health Commercial |
$2,885.15
|
| Rate for Payer: Humana Commercial |
$2,581.45
|
| Rate for Payer: Humana KY Medicaid |
$1,044.42
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,672.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.53
|
| Rate for Payer: PHCS Commercial |
$2,915.52
|
| Rate for Payer: United Healthcare All Payer |
$2,672.56
|
|
|
CT LUMBAR SPINE W WO CONTRAST
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
35000048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$1,822.20 |
| Rate for Payer: Aetna Commercial |
$616.99
|
| Rate for Payer: Ambetter Exchange |
$180.48
|
| Rate for Payer: Anthem Medicaid |
$293.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$216.58
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$611.81
|
| Rate for Payer: Healthspan PPO |
$423.96
|
| Rate for Payer: Humana Medicaid |
$293.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.08
|
| Rate for Payer: Molina Healthcare Passport |
$293.22
|
| Rate for Payer: Multiplan PHCS |
$1,822.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.62
|
| Rate for Payer: UHCCP Medicaid |
$1,062.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.48
|
|
|
CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
35000048
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$911.10 |
| Max. Negotiated Rate |
$2,915.52 |
| Rate for Payer: Aetna Commercial |
$2,338.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.86
|
| Rate for Payer: Cash Price |
$1,518.50
|
| Rate for Payer: Cigna Commercial |
$2,520.71
|
| Rate for Payer: First Health Commercial |
$2,885.15
|
| Rate for Payer: Humana Commercial |
$2,581.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,490.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,241.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,672.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,642.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.53
|
| Rate for Payer: PHCS Commercial |
$2,915.52
|
| Rate for Payer: United Healthcare All Payer |
$2,672.56
|
|
|
CT LUNG CANCER SCREENING SP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
222T0547
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
CT LUNG CANCER SCREENING SP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
22200547
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
CT LUNG CANCER SCREENING SP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
22200547
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
CT LUNG CANCER SCREENING SP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 71271
|
| Hospital Charge Code |
222T0547
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
CT LWR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$2,942.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
35000057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$882.60 |
| Max. Negotiated Rate |
$2,824.32 |
| Rate for Payer: Aetna Commercial |
$2,265.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,294.76
|
| Rate for Payer: Cash Price |
$1,471.00
|
| Rate for Payer: Cigna Commercial |
$2,441.86
|
| Rate for Payer: First Health Commercial |
$2,794.90
|
| Rate for Payer: Humana Commercial |
$2,500.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,412.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,171.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,353.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,559.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.98
|
| Rate for Payer: PHCS Commercial |
$2,824.32
|
| Rate for Payer: United Healthcare All Payer |
$2,588.96
|
|
|
CT LWR EXTREMITY W/O&W/DYE
|
Professional
|
Both
|
$2,942.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
35000057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$1,765.20 |
| Rate for Payer: Aetna Commercial |
$611.62
|
| Rate for Payer: Ambetter Exchange |
$178.83
|
| Rate for Payer: Anthem Medicaid |
$252.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.60
|
| Rate for Payer: Cash Price |
$1,471.00
|
| Rate for Payer: Cash Price |
$1,471.00
|
| Rate for Payer: Cigna Commercial |
$553.09
|
| Rate for Payer: Healthspan PPO |
$420.28
|
| Rate for Payer: Humana Medicaid |
$252.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.85
|
| Rate for Payer: Molina Healthcare Passport |
$252.79
|
| Rate for Payer: Multiplan PHCS |
$1,765.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.48
|
| Rate for Payer: UHCCP Medicaid |
$1,029.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.83
|
|
|
CT LWR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$2,942.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
35000057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,824.32 |
| Rate for Payer: Aetna Commercial |
$2,265.34
|
| Rate for Payer: Anthem Medicaid |
$1,011.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,294.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,471.00
|
| Rate for Payer: Cash Price |
$1,471.00
|
| Rate for Payer: Cigna Commercial |
$2,441.86
|
| Rate for Payer: First Health Commercial |
$2,794.90
|
| Rate for Payer: Humana Commercial |
$2,500.70
|
| Rate for Payer: Humana KY Medicaid |
$1,011.75
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,022.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,412.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,171.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,032.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,353.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,559.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.98
|
| Rate for Payer: PHCS Commercial |
$2,824.32
|
| Rate for Payer: United Healthcare All Payer |
$2,588.96
|
|
|
CT LWR EXTREMITY W/O&W/DYE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
350P0057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$611.62 |
| Rate for Payer: Aetna Commercial |
$611.62
|
| Rate for Payer: Ambetter Exchange |
$178.83
|
| Rate for Payer: Anthem Medicaid |
$252.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.60
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$553.09
|
| Rate for Payer: Healthspan PPO |
$420.28
|
| Rate for Payer: Humana Medicaid |
$252.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$257.85
|
| Rate for Payer: Molina Healthcare Passport |
$252.79
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.48
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.83
|
|
|
CT LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
350T0057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,584.32 |
| Rate for Payer: Aetna Commercial |
$2,072.84
|
| Rate for Payer: Anthem Medicaid |
$925.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,099.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,346.00
|
| Rate for Payer: Cash Price |
$1,346.00
|
| Rate for Payer: Cigna Commercial |
$2,234.36
|
| Rate for Payer: First Health Commercial |
$2,557.40
|
| Rate for Payer: Humana Commercial |
$2,288.20
|
| Rate for Payer: Humana KY Medicaid |
$925.78
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$935.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,207.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,986.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$944.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,368.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,019.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,342.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,857.48
|
| Rate for Payer: PHCS Commercial |
$2,584.32
|
| Rate for Payer: United Healthcare All Payer |
$2,368.96
|
|
|
CT LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
350T0057
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$807.60 |
| Max. Negotiated Rate |
$2,584.32 |
| Rate for Payer: Aetna Commercial |
$2,072.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,099.76
|
| Rate for Payer: Cash Price |
$1,346.00
|
| Rate for Payer: Cigna Commercial |
$2,234.36
|
| Rate for Payer: First Health Commercial |
$2,557.40
|
| Rate for Payer: Humana Commercial |
$2,288.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,207.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,986.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,368.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,019.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,342.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,857.48
|
| Rate for Payer: PHCS Commercial |
$2,584.32
|
| Rate for Payer: United Healthcare All Payer |
$2,368.96
|
|
