|
CT NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
350T0035
|
|
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 NECK-SOFT TISSUE W/CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
350P0035
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$507.24 |
| Rate for Payer: Aetna Commercial |
$507.24
|
| Rate for Payer: Ambetter Exchange |
$169.31
|
| Rate for Payer: Anthem Medicaid |
$212.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$169.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$169.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$203.17
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$450.94
|
| Rate for Payer: Healthspan PPO |
$348.55
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$169.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.31
|
| 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 |
$220.10
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$214.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$169.31
|
|
|
CT NECK-SOFT TISSUE W/CONTRAST
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
35000035
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$1,702.20 |
| Rate for Payer: Aetna Commercial |
$507.24
|
| Rate for Payer: Ambetter Exchange |
$169.31
|
| Rate for Payer: Anthem Medicaid |
$212.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$169.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$169.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$203.17
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$450.94
|
| Rate for Payer: Healthspan PPO |
$348.55
|
| Rate for Payer: Humana Medicaid |
$212.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$169.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.31
|
| 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 |
$220.10
|
| Rate for Payer: UHCCP Medicaid |
$992.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$214.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$169.31
|
|
|
CT NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
35000035
|
|
Hospital Revenue Code
|
352
|
| 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 NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
350T0035
|
|
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 NECK-SOFT TISSUE W/CONTRAST
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 70491
|
| Hospital Charge Code |
35000035
|
|
Hospital Revenue Code
|
352
|
| 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 NECK-SOFT TISSUE W/O DYE
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
352
|
| 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 NECK-SOFT TISSUE W/O DYE
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Ambetter Exchange |
$138.63
|
| Rate for Payer: Anthem Medicaid |
$182.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$138.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$166.36
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$382.68
|
| Rate for Payer: Healthspan PPO |
$272.38
|
| 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 |
$138.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.63
|
| 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 |
$180.22
|
| Rate for Payer: UHCCP Medicaid |
$922.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$138.63
|
|
|
CT NECK-SOFT TISSUE W/O DYE
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
352
|
| 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 NECK-SOFT TISSUE W/O DYE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
350P0034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$396.39 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Ambetter Exchange |
$138.63
|
| Rate for Payer: Anthem Medicaid |
$182.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$138.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$166.36
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$382.68
|
| Rate for Payer: Healthspan PPO |
$272.38
|
| 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 |
$138.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.63
|
| 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 |
$180.22
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$138.63
|
|
|
CT NECK-SOFT TISSUE W/O DYE(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
350T0034
|
|
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 NECK-SOFT TISSUE W/O DYE(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 70490
|
| Hospital Charge Code |
350T0034
|
|
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 NECK-SOFT TISSUE W/WO CON(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
350P0036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$614.73 |
| Rate for Payer: Aetna Commercial |
$614.73
|
| Rate for Payer: Ambetter Exchange |
$203.04
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$203.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$203.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.65
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$544.47
|
| Rate for Payer: Healthspan PPO |
$422.41
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$203.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$263.95
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$203.04
|
|
|
CT NECK-SOFT TISSUE W/WO CON(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
350T0036
|
|
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 NECK-SOFT TISSUE W/WO CON(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
350T0036
|
|
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 NECK-SOFT TISSUE W/WO CONT
|
Facility
|
IP
|
$3,062.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
35000036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,357.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,388.36
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$2,541.46
|
| Rate for Payer: First Health Commercial |
$2,908.90
|
| Rate for Payer: Humana Commercial |
$2,602.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,510.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,259.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$918.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,694.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,296.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.78
|
| Rate for Payer: PHCS Commercial |
$2,939.52
|
| Rate for Payer: United Healthcare All Payer |
$2,694.56
|
|
|
CT NECK-SOFT TISSUE W/WO CONT
|
Professional
|
Both
|
$3,062.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
35000036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$1,837.20 |
| Rate for Payer: Aetna Commercial |
$614.73
|
| Rate for Payer: Ambetter Exchange |
$203.04
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$203.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$203.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.65
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$544.47
|
| Rate for Payer: Healthspan PPO |
$422.41
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$203.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$1,837.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$263.95
|
| Rate for Payer: UHCCP Medicaid |
$1,071.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$203.04
|
|
|
CT NECK-SOFT TISSUE W/WO CONT
|
Facility
|
OP
|
$3,062.00
|
|
|
Service Code
|
HCPCS 70492
|
| Hospital Charge Code |
35000036
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,357.74
|
| Rate for Payer: Anthem Medicaid |
$1,053.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,388.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$2,541.46
|
| Rate for Payer: First Health Commercial |
$2,908.90
|
| Rate for Payer: Humana Commercial |
$2,602.70
|
| Rate for Payer: Humana KY Medicaid |
$1,053.02
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,063.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,510.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,259.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,074.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,694.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,296.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.78
|
| Rate for Payer: PHCS Commercial |
$2,939.52
|
| Rate for Payer: United Healthcare All Payer |
$2,694.56
|
|
|
CT ORBIT W/WO CONTRAST
|
Facility
|
IP
|
$3,062.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$918.60 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,357.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,388.36
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$2,541.46
|
| Rate for Payer: First Health Commercial |
$2,908.90
|
| Rate for Payer: Humana Commercial |
$2,602.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,510.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,259.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$918.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,694.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,296.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.78
|
| Rate for Payer: PHCS Commercial |
$2,939.52
|
| Rate for Payer: United Healthcare All Payer |
$2,694.56
|
|
|
CT ORBIT W/WO CONTRAST
|
Facility
|
OP
|
$3,062.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,939.52 |
| Rate for Payer: Aetna Commercial |
$2,357.74
|
| Rate for Payer: Anthem Medicaid |
$1,053.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,388.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$2,541.46
|
| Rate for Payer: First Health Commercial |
$2,908.90
|
| Rate for Payer: Humana Commercial |
$2,602.70
|
| Rate for Payer: Humana KY Medicaid |
$1,053.02
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,063.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,510.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,259.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,074.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,694.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,296.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,663.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.78
|
| Rate for Payer: PHCS Commercial |
$2,939.52
|
| Rate for Payer: United Healthcare All Payer |
$2,694.56
|
|
|
CT ORBIT W/WO CONTRAST
|
Professional
|
Both
|
$3,062.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
35000027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$1,837.20 |
| Rate for Payer: Aetna Commercial |
$628.11
|
| Rate for Payer: Ambetter Exchange |
$192.27
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$230.72
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cash Price |
$1,531.00
|
| Rate for Payer: Cigna Commercial |
$562.12
|
| Rate for Payer: Healthspan PPO |
$431.61
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$1,837.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$249.95
|
| Rate for Payer: UHCCP Medicaid |
$1,071.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.27
|
|
|
CT ORBIT W/WO CONTRAST(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
350P0027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$628.11 |
| Rate for Payer: Aetna Commercial |
$628.11
|
| Rate for Payer: Ambetter Exchange |
$192.27
|
| Rate for Payer: Anthem Medicaid |
$253.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$230.72
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$562.12
|
| Rate for Payer: Healthspan PPO |
$431.61
|
| Rate for Payer: Humana Medicaid |
$253.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.44
|
| Rate for Payer: Molina Healthcare Passport |
$253.37
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$249.95
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.27
|
|
|
CT ORBIT W/WO CONTRAST(T
|
Facility
|
IP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
350T0027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$836.10 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$836.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
CT ORBIT W/WO CONTRAST(T
|
Facility
|
OP
|
$2,787.00
|
|
|
Service Code
|
HCPCS 70482
|
| Hospital Charge Code |
350T0027
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,675.52 |
| Rate for Payer: Aetna Commercial |
$2,145.99
|
| Rate for Payer: Anthem Medicaid |
$958.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,173.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cash Price |
$1,393.50
|
| Rate for Payer: Cigna Commercial |
$2,313.21
|
| Rate for Payer: First Health Commercial |
$2,647.65
|
| Rate for Payer: Humana Commercial |
$2,368.95
|
| Rate for Payer: Humana KY Medicaid |
$958.45
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$968.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,285.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,056.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$977.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,452.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,090.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,424.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.03
|
| Rate for Payer: PHCS Commercial |
$2,675.52
|
| Rate for Payer: United Healthcare All Payer |
$2,452.56
|
|
|
CT PELVIS W/CONTRAST
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
HCPCS 72193
|
| Hospital Charge Code |
35000050
|
|
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
|
|
