|
X-RAY EXAM HIPS BI 2 VIEWS
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$689.00 |
| Rate for Payer: Anthem Medicaid |
$29.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.00
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cash Price |
$344.50
|
| Rate for Payer: Cigna Commercial |
$61.93
|
| Rate for Payer: Humana Medicaid |
$29.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.37
|
| Rate for Payer: Molina Healthcare Passport |
$29.77
|
| Rate for Payer: Multiplan PHCS |
$413.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$482.30
|
| Rate for Payer: UHCCP Medicaid |
$241.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.07
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$537.42
|
| 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: 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 |
$206.70
|
| 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
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
320P0277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Anthem Medicaid |
$29.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$61.93
|
| Rate for Payer: Humana Medicaid |
$29.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.37
|
| Rate for Payer: Molina Healthcare Passport |
$29.77
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.07
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS(T
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
320T0277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.57 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem Medicaid |
$168.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Humana KY Medicaid |
$168.17
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$169.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.59
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS(T
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
320T0277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.57 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.42
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.59
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEW(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
320P0278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Anthem Medicaid |
$36.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$76.51
|
| Rate for Payer: Humana Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.21
|
| Rate for Payer: Molina Healthcare Passport |
$36.48
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.84
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
32000278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$575.19
|
| Rate for Payer: Anthem Medicaid |
$256.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$620.01
|
| Rate for Payer: First Health Commercial |
$709.65
|
| Rate for Payer: Humana Commercial |
$634.95
|
| Rate for Payer: Humana KY Medicaid |
$256.89
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$259.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.36
|
| Rate for Payer: Ohio Health Group HMO |
$560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.57
|
| Rate for Payer: PHCS Commercial |
$717.12
|
| Rate for Payer: United Healthcare All Payer |
$657.36
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
32000278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Anthem Medicaid |
$36.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$747.00
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$76.51
|
| Rate for Payer: Humana Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.21
|
| Rate for Payer: Molina Healthcare Passport |
$36.48
|
| Rate for Payer: Multiplan PHCS |
$448.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.90
|
| Rate for Payer: UHCCP Medicaid |
$261.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.84
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
32000278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.11 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$575.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.66
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$620.01
|
| Rate for Payer: First Health Commercial |
$709.65
|
| Rate for Payer: Humana Commercial |
$634.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.36
|
| Rate for Payer: Ohio Health Group HMO |
$560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.57
|
| Rate for Payer: PHCS Commercial |
$717.12
|
| Rate for Payer: United Healthcare All Payer |
$657.36
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEW(T
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
320T0278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$413.49
|
| Rate for Payer: Anthem Medicaid |
$184.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$445.71
|
| Rate for Payer: First Health Commercial |
$510.15
|
| Rate for Payer: Humana Commercial |
$456.45
|
| Rate for Payer: Humana KY Medicaid |
$184.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$186.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.56
|
| Rate for Payer: Ohio Health Group HMO |
$402.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.47
|
| Rate for Payer: PHCS Commercial |
$515.52
|
| Rate for Payer: United Healthcare All Payer |
$472.56
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEW(T
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
320T0278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$413.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.86
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$445.71
|
| Rate for Payer: First Health Commercial |
$510.15
|
| Rate for Payer: Humana Commercial |
$456.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.56
|
| Rate for Payer: Ohio Health Group HMO |
$402.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.47
|
| Rate for Payer: PHCS Commercial |
$515.52
|
| Rate for Payer: United Healthcare All Payer |
$472.56
|
|
|
X-RAY EXAM HIPS BI 5/> VIEW(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
320P0096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Anthem Medicaid |
$42.25
|
| 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 |
$88.69
|
| Rate for Payer: Humana Medicaid |
$42.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.10
|
| Rate for Payer: Molina Healthcare Passport |
$42.25
|
| 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 |
$42.67
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
|
IP
|
$767.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
32000096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.71 |
| Max. Negotiated Rate |
$736.32 |
| Rate for Payer: Aetna Commercial |
$590.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.26
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$636.61
|
| Rate for Payer: First Health Commercial |
$728.65
|
| Rate for Payer: Humana Commercial |
$651.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.96
|
| Rate for Payer: Ohio Health Group HMO |
$575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.77
|
| Rate for Payer: PHCS Commercial |
$736.32
|
| Rate for Payer: United Healthcare All Payer |
$674.96
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Professional
|
Both
|
$767.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
32000096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$767.00 |
| Rate for Payer: Anthem Medicaid |
$42.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$767.00
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$88.69
|
| Rate for Payer: Humana Medicaid |
$42.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.10
|
| Rate for Payer: Molina Healthcare Passport |
$42.25
|
| Rate for Payer: Multiplan PHCS |
$460.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$536.90
|
| Rate for Payer: UHCCP Medicaid |
$268.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.67
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
|
OP
|
$767.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
32000096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$736.32 |
| Rate for Payer: Aetna Commercial |
$590.59
|
| Rate for Payer: Anthem Medicaid |
$263.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Cigna Commercial |
$636.61
|
| Rate for Payer: First Health Commercial |
$728.65
|
| Rate for Payer: Humana Commercial |
$651.95
|
| Rate for Payer: Humana KY Medicaid |
$263.77
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$266.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.96
|
| Rate for Payer: Ohio Health Group HMO |
$575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.77
|
| Rate for Payer: PHCS Commercial |
$736.32
|
| Rate for Payer: United Healthcare All Payer |
$674.96
|
|
|
X-RAY EXAM HIPS BI 5/> VIEW(T
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
320T0096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
X-RAY EXAM HIPS BI 5/> VIEW(T
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
320T0096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem Medicaid |
$188.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Humana KY Medicaid |
$188.11
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$190.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
X-RAY EXAM HIP UNI 4/> VIEW(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
320P0276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Anthem Medicaid |
$38.47
|
| 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 |
$80.84
|
| Rate for Payer: Humana Medicaid |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.24
|
| Rate for Payer: Molina Healthcare Passport |
$38.47
|
| 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 |
$38.85
|
|
|
X-RAY EXAM HIP UNI 4/> VIEWS
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
32000276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$685.44 |
| Rate for Payer: Aetna Commercial |
$549.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$592.62
|
| Rate for Payer: First Health Commercial |
$678.30
|
| Rate for Payer: Humana Commercial |
$606.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$585.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$628.32
|
| Rate for Payer: Ohio Health Group HMO |
$535.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.34
|
| Rate for Payer: PHCS Commercial |
$685.44
|
| Rate for Payer: United Healthcare All Payer |
$628.32
|
|
|
X-RAY EXAM HIP UNI 4/> VIEWS
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
32000276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$685.44 |
| Rate for Payer: Aetna Commercial |
$549.78
|
| Rate for Payer: Anthem Medicaid |
$245.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$592.62
|
| Rate for Payer: First Health Commercial |
$678.30
|
| Rate for Payer: Humana Commercial |
$606.90
|
| Rate for Payer: Humana KY Medicaid |
$245.54
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$248.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$585.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$628.32
|
| Rate for Payer: Ohio Health Group HMO |
$535.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.34
|
| Rate for Payer: PHCS Commercial |
$685.44
|
| Rate for Payer: United Healthcare All Payer |
$628.32
|
|
|
X-RAY EXAM HIP UNI 4/> VIEWS
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
32000276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Anthem Medicaid |
$38.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$714.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$80.84
|
| Rate for Payer: Humana Medicaid |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.24
|
| Rate for Payer: Molina Healthcare Passport |
$38.47
|
| Rate for Payer: Multiplan PHCS |
$428.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$499.80
|
| Rate for Payer: UHCCP Medicaid |
$249.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.85
|
|
|
X-RAY EXAM HIP UNI 4/> VIEW(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
320T0276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
X-RAY EXAM HIP UNI 4/> VIEW(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
320T0276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
X-RAY EXAM L-S SPINE BENDING
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
X-RAY EXAM L-S SPINE BENDING
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
