|
X-RAY EXAM L-S SPINE BENDING
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna Commercial |
$106.23
|
| Rate for Payer: Anthem Medicaid |
$47.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.00
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$98.42
|
| Rate for Payer: Healthspan PPO |
$99.52
|
| Rate for Payer: Humana Medicaid |
$47.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.57
|
| Rate for Payer: Molina Healthcare Passport |
$47.62
|
| Rate for Payer: Multiplan PHCS |
$250.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$291.90
|
| Rate for Payer: UHCCP Medicaid |
$145.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.10
|
|
|
X-RAY EXAM L-S SPINE BENDIN(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
320P0054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$106.23 |
| Rate for Payer: Aetna Commercial |
$106.23
|
| Rate for Payer: Anthem Medicaid |
$47.62
|
| 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 |
$98.42
|
| Rate for Payer: Healthspan PPO |
$99.52
|
| Rate for Payer: Humana Medicaid |
$47.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.57
|
| Rate for Payer: Molina Healthcare Passport |
$47.62
|
| 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 |
$48.10
|
|
|
X-RAY EXAM L-S SPINE BENDIN(T
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
320T0054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem Medicaid |
$126.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Humana KY Medicaid |
$126.21
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
X-RAY EXAM L-S SPINE BENDIN(T
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
320T0054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
X-RAY EXAM OF ARM INFANT
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.01
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
X-RAY EXAM OF ARM INFANT
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$371.00
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$222.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.70
|
| Rate for Payer: UHCCP Medicaid |
$129.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
|
X-RAY EXAM OF ARM INFANT
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Humana KY Medicaid |
$127.59
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$128.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.01
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
X-RAY EXAM OF ARM INFANT(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
320P0083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| 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 |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| 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 |
$20.35
|
|
|
X-RAY EXAM OF ARM INFANT(T
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
320T0083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.51
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
X-RAY EXAM OF ARM INFANT(T
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
320T0083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem Medicaid |
$110.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Humana KY Medicaid |
$110.39
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.51
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
X-RAY EXAM OF KNEES
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
32000102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.79
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
X-RAY EXAM OF KNEES
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
32000102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.79
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
X-RAY EXAM OF KNEES
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
32000102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Anthem Medicaid |
$20.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.00
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$42.90
|
| Rate for Payer: Healthspan PPO |
$42.28
|
| Rate for Payer: Humana Medicaid |
$20.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.85
|
| Rate for Payer: Molina Healthcare Passport |
$20.44
|
| Rate for Payer: Multiplan PHCS |
$185.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$216.30
|
| Rate for Payer: UHCCP Medicaid |
$108.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.64
|
|
|
X-RAY EXAM OF KNEES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
320P0102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Anthem Medicaid |
$20.44
|
| 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 |
$42.90
|
| Rate for Payer: Healthspan PPO |
$42.28
|
| Rate for Payer: Humana Medicaid |
$20.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.85
|
| Rate for Payer: Molina Healthcare Passport |
$20.44
|
| 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 |
$20.64
|
|
|
X-RAY EXAM OF KNEES(T
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
320T0102
|
|
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 OF KNEES(T
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
320T0102
|
|
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 OF LEG INFANT
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Humana KY Medicaid |
$127.59
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$128.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.01
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
X-RAY EXAM OF LEG INFANT
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.01
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
X-RAY EXAM OF LEG INFANT
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$371.00
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$222.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.70
|
| Rate for Payer: UHCCP Medicaid |
$129.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
|
X-RAY EXAM OF LEG INFANT(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
320P0105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| 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 |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| 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 |
$20.35
|
|
|
X-RAY EXAM OF LEG INFANT(T
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
320T0105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem Medicaid |
$110.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Humana KY Medicaid |
$110.39
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.51
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
X-RAY EXAM OF LEG INFANT(T
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
320T0105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.51
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
X-RAY EXAM OF NECK
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
X-RAY EXAM OF NECK
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$443.00 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$443.00
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$38.14
|
| Rate for Payer: Healthspan PPO |
$38.28
|
| Rate for Payer: Humana Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.21
|
| Rate for Payer: Molina Healthcare Passport |
$18.83
|
| Rate for Payer: Multiplan PHCS |
$265.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$310.10
|
| Rate for Payer: UHCCP Medicaid |
$155.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.02
|
|
|
X-RAY EXAM OF NECK
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem Medicaid |
$152.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Humana KY Medicaid |
$152.35
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$153.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
