|
X-RAY EXAM OF NECK(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
320P0019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.02
|
|
|
X-RAY EXAM OF NECK(T
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
320T0019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.34
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
X-RAY EXAM OF NECK(T
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
320T0019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$310.31
|
| Rate for Payer: Anthem Medicaid |
$138.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cigna Commercial |
$334.49
|
| Rate for Payer: First Health Commercial |
$382.85
|
| Rate for Payer: Humana Commercial |
$342.55
|
| Rate for Payer: Humana KY Medicaid |
$138.59
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$330.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$297.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$354.64
|
| Rate for Payer: Ohio Health Group HMO |
$302.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.93
|
| Rate for Payer: PHCS Commercial |
$386.88
|
| Rate for Payer: United Healthcare All Payer |
$354.64
|
|
|
X-RAY EXAM OF SALIVARY DUCT
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.41 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem Medicaid |
$329.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Humana KY Medicaid |
$329.11
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$332.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.67
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
X-RAY EXAM OF SALIVARY DUCT
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.41 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.67
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
X-RAY EXAM OF SALIVARY DUCT
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$957.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Anthem Medicaid |
$64.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$957.00
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$136.61
|
| Rate for Payer: Healthspan PPO |
$140.55
|
| Rate for Payer: Humana Medicaid |
$64.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.00
|
| Rate for Payer: Molina Healthcare Passport |
$64.71
|
| Rate for Payer: Multiplan PHCS |
$574.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$669.90
|
| Rate for Payer: UHCCP Medicaid |
$334.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.36
|
|
|
X-RAY EXAM OF SALIVARY DUCT(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
320P0267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Anthem Medicaid |
$64.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$136.61
|
| Rate for Payer: Healthspan PPO |
$140.55
|
| Rate for Payer: Humana Medicaid |
$64.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.00
|
| Rate for Payer: Molina Healthcare Passport |
$64.71
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.36
|
|
|
X-RAY EXAM OF SALIVARY DUCT(T
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
320T0267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$846.72 |
| Rate for Payer: Aetna Commercial |
$679.14
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$687.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$732.06
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: Humana Commercial |
$749.70
|
| Rate for Payer: Humana KY Medicaid |
$303.32
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$306.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$723.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$309.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$776.16
|
| Rate for Payer: Ohio Health Group HMO |
$661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.42
|
| Rate for Payer: PHCS Commercial |
$846.72
|
| Rate for Payer: United Healthcare All Payer |
$776.16
|
|
|
X-RAY EXAM OF SALIVARY DUCT(T
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
320T0267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$846.72 |
| Rate for Payer: Aetna Commercial |
$679.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$687.96
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$732.06
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: Humana Commercial |
$749.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$723.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$776.16
|
| Rate for Payer: Ohio Health Group HMO |
$661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.42
|
| Rate for Payer: PHCS Commercial |
$846.72
|
| Rate for Payer: United Healthcare All Payer |
$776.16
|
|
|
X-RAY EXAM OF SHOULDER BLADE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
X-RAY EXAM OF SHOULDER BLADE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$42.53
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
|
|
X-RAY EXAM OF SHOULDER BLADE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
X-RAY EXAM OF SHOULDER BLAD(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
320P0073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| 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 |
$42.53
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| 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 |
$21.74
|
|
|
X-RAY EXAM OF SHOULDER BLAD(T
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
320T0073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
X-RAY EXAM OF SHOULDER BLAD(T
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
320T0073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$89.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$89.41
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$90.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
X-RAY EXAM OFSHOULDER MIN 2(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
320P0075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.92
|
| Rate for Payer: Healthspan PPO |
$42.66
|
| Rate for Payer: Humana Medicaid |
$23.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.59
|
| Rate for Payer: Molina Healthcare Passport |
$23.13
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.36
|
|
|
X-RAY EXAM OFSHOULDER MIN 2(T
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
320T0075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
X-RAY EXAM OFSHOULDER MIN 2(T
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
320T0075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
X-RAY EXAM OFSHOULDER MIN 2V
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$410.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$45.92
|
| Rate for Payer: Healthspan PPO |
$42.66
|
| Rate for Payer: Humana Medicaid |
$23.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.59
|
| Rate for Payer: Molina Healthcare Passport |
$23.13
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.00
|
| Rate for Payer: UHCCP Medicaid |
$143.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.36
|
|
|
X-RAY EXAM OFSHOULDER MIN 2V
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem Medicaid |
$141.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Humana KY Medicaid |
$141.00
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$142.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
X-RAY EXAM OFSHOULDER MIN 2V
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
X-RAY EXAM OF SINUSES
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$59.37
|
| Rate for Payer: Anthem Medicaid |
$32.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$61.61
|
| Rate for Payer: Healthspan PPO |
$55.64
|
| Rate for Payer: Humana Medicaid |
$32.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.02
|
| Rate for Payer: Molina Healthcare Passport |
$32.37
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.69
|
|
|
X-RAY EXAM OF SINUSES
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
X-RAY EXAM OF SINUSES
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| 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 OF SINUSES
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Anthem Medicaid |
$24.17
|
| 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 |
$47.54
|
| Rate for Payer: Healthspan PPO |
$42.62
|
| Rate for Payer: Humana Medicaid |
$24.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.65
|
| Rate for Payer: Molina Healthcare Passport |
$24.17
|
| 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 |
$24.41
|
|
