|
XRAY CONTROL CATHETER CHANGE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320P1021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.64
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
|
|
XRAY CONTROL CATHETER CHANGE(T
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T1021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.12
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
XRAY CONTROL CATHETER CHANGE(T
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T1021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem Medicaid |
$121.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Humana KY Medicaid |
$121.05
|
| Rate for Payer: Kentucky WC Medicaid |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.12
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
XRAY CONTROL CATHETER CHANG(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320P0179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.64
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
|
|
XRAY CONTROL CATHETER CHANG(T
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T0179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem Medicaid |
$121.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Humana KY Medicaid |
$121.05
|
| Rate for Payer: Kentucky WC Medicaid |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.12
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
XRAY CONTROL CATHETER CHANG(T
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T0179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.12
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
X-RAY EXAM BREASTBONE 2/>VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
320P0040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Anthem Medicaid |
$26.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$51.50
|
| Rate for Payer: Healthspan PPO |
$46.76
|
| Rate for Payer: Humana Medicaid |
$26.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.65
|
| Rate for Payer: Molina Healthcare Passport |
$26.13
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.39
|
|
|
X-RAY EXAM BREASTBONE 2/>VWS
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
X-RAY EXAM BREASTBONE 2/>VWS
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem Medicaid |
$131.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Humana KY Medicaid |
$131.37
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$132.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
X-RAY EXAM BREASTBONE 2/>VWS
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Anthem Medicaid |
$26.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$51.50
|
| Rate for Payer: Healthspan PPO |
$46.76
|
| Rate for Payer: Humana Medicaid |
$26.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.65
|
| Rate for Payer: Molina Healthcare Passport |
$26.13
|
| Rate for Payer: Multiplan PHCS |
$229.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$133.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.39
|
|
|
X-RAY EXAM BREASTBONE 2/>VW(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
320T0040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
X-RAY EXAM BREASTBONE 2/>VW(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
320T0040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem Medicaid |
$163.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Humana KY Medicaid |
$163.01
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$164.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.94
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Anthem Medicaid |
$29.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$474.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$61.00
|
| Rate for Payer: Humana Medicaid |
$29.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.70
|
| Rate for Payer: Molina Healthcare Passport |
$29.12
|
| Rate for Payer: Multiplan PHCS |
$284.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$331.80
|
| Rate for Payer: UHCCP Medicaid |
$165.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.41
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.94
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
320P0051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Anthem Medicaid |
$29.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$61.00
|
| Rate for Payer: Humana Medicaid |
$29.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.70
|
| Rate for Payer: Molina Healthcare Passport |
$29.12
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.41
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW(T
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
320T0051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW(T
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
320T0051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$89.07
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$89.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 V(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
320P0270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Anthem Medicaid |
$46.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$97.49
|
| Rate for Payer: Humana Medicaid |
$46.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.32
|
| Rate for Payer: Molina Healthcare Passport |
$46.39
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.85
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 V(T
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
320T0270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem Medicaid |
$166.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Humana KY Medicaid |
$166.10
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$167.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 V(T
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
320T0270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 VW
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
32000270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$674.88 |
| Rate for Payer: Aetna Commercial |
$541.31
|
| Rate for Payer: Anthem Medicaid |
$241.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$548.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$583.49
|
| Rate for Payer: First Health Commercial |
$667.85
|
| Rate for Payer: Humana Commercial |
$597.55
|
| Rate for Payer: Humana KY Medicaid |
$241.76
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$244.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$576.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$518.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$246.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$618.64
|
| Rate for Payer: Ohio Health Group HMO |
$527.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.93
|
| Rate for Payer: PHCS Commercial |
$674.88
|
| Rate for Payer: United Healthcare All Payer |
$618.64
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 VW
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
32000270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Anthem Medicaid |
$46.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$703.00
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$97.49
|
| Rate for Payer: Humana Medicaid |
$46.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.32
|
| Rate for Payer: Molina Healthcare Passport |
$46.39
|
| Rate for Payer: Multiplan PHCS |
$421.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$492.10
|
| Rate for Payer: UHCCP Medicaid |
$246.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.85
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 VW
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
32000270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$674.88 |
| Rate for Payer: Aetna Commercial |
$541.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$548.34
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$583.49
|
| Rate for Payer: First Health Commercial |
$667.85
|
| Rate for Payer: Humana Commercial |
$597.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$576.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$518.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$618.64
|
| Rate for Payer: Ohio Health Group HMO |
$527.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.93
|
| Rate for Payer: PHCS Commercial |
$674.88
|
| Rate for Payer: United Healthcare All Payer |
$618.64
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.57 |
| Max. Negotiated Rate |
$661.44 |
| Rate for Payer: Aetna Commercial |
$530.53
|
| Rate for Payer: Anthem Medicaid |
$236.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$537.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cigna Commercial |
$571.87
|
| Rate for Payer: First Health Commercial |
$654.55
|
| Rate for Payer: Humana Commercial |
$585.65
|
| Rate for Payer: Humana KY Medicaid |
$236.95
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$239.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$564.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$508.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$241.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$606.32
|
| Rate for Payer: Ohio Health Group HMO |
$516.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.59
|
| Rate for Payer: PHCS Commercial |
$661.44
|
| Rate for Payer: United Healthcare All Payer |
$606.32
|
|
