|
X-RAY EXAM RIBS/CHEST4/> VW(T
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
320T0039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Anthem Medicaid |
$175.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$484.50
|
| Rate for Payer: Humana Commercial |
$433.50
|
| Rate for Payer: Humana KY Medicaid |
$175.39
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$177.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.80
|
| Rate for Payer: Ohio Health Group HMO |
$382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.10
|
| Rate for Payer: PHCS Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Payer |
$448.80
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$49.98
|
| Rate for Payer: Anthem Medicaid |
$25.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$49.38
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$25.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.58
|
| Rate for Payer: Molina Healthcare Passport |
$25.08
|
| Rate for Payer: Multiplan PHCS |
$248.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$289.80
|
| Rate for Payer: UHCCP Medicaid |
$144.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.33
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$142.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$142.37
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
320P0037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$49.98
|
| Rate for Payer: Anthem Medicaid |
$25.08
|
| 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 |
$49.38
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$25.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.58
|
| Rate for Payer: Molina Healthcare Passport |
$25.08
|
| 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 |
$25.33
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS(T
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
320T0037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.84
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS(T
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
320T0037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Humana KY Medicaid |
$125.18
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$126.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.84
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
X-RAY EXAM SACRUM TAILBONE
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
32000069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.02
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
X-RAY EXAM SACRUM TAILBONE
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
32000069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem Medicaid |
$152.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Humana KY Medicaid |
$152.00
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$153.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.02
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
X-RAY EXAM SACRUM TAILBONE
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
32000069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$442.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$42.12
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$265.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.40
|
| Rate for Payer: UHCCP Medicaid |
$154.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
|
|
X-RAY EXAM SACRUM TAILBONE(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
320P0069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$45.33 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| 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 |
$45.33
|
| Rate for Payer: Healthspan PPO |
$42.12
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| 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 |
$23.06
|
|
|
X-RAY EXAM SACRUM TAILBONE(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
320T0069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
X-RAY EXAM SACRUM TAILBONE(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
320T0069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
X-RAY EXAM SI JOINTS 3/> VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
610P0027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$53.07
|
| Rate for Payer: Anthem Medicaid |
$25.03
|
| 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 |
$50.94
|
| Rate for Payer: Healthspan PPO |
$49.72
|
| Rate for Payer: Humana Medicaid |
$25.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.53
|
| Rate for Payer: Molina Healthcare Passport |
$25.03
|
| 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 |
$25.28
|
|
|
X-RAY EXAM SI JOINTS 3/> VWS
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.43
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
X-RAY EXAM SI JOINTS 3/> VWS
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem Medicaid |
$155.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Humana KY Medicaid |
$155.79
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$157.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.43
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
X-RAY EXAM SI JOINTS 3/> VWS
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$53.07
|
| Rate for Payer: Anthem Medicaid |
$25.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.00
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$50.94
|
| Rate for Payer: Healthspan PPO |
$49.72
|
| Rate for Payer: Humana Medicaid |
$25.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.53
|
| Rate for Payer: Molina Healthcare Passport |
$25.03
|
| Rate for Payer: Multiplan PHCS |
$271.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.10
|
| Rate for Payer: UHCCP Medicaid |
$158.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.28
|
|
|
X-RAY EXAM SI JOINTS 3/> VW(T
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
610T0027
|
|
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 |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$314.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| 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 |
$95.07
|
| 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 |
$114.08
|
| 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 SI JOINTS 3/> VW(T
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
610T0027
|
|
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
|
|
|
XRAY EXAM SKULL COMP, MIN 4V
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
XRAY EXAM SKULL COMP, MIN 4V
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
XRAY EXAM SKULL COMP, MIN 4V
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Aetna Commercial |
$73.49
|
| Rate for Payer: Anthem Medicaid |
$39.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$534.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$75.77
|
| Rate for Payer: Healthspan PPO |
$68.86
|
| Rate for Payer: Humana Medicaid |
$39.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.01
|
| Rate for Payer: Multiplan PHCS |
$320.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$373.80
|
| Rate for Payer: UHCCP Medicaid |
$186.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.40
|
|
|
XRAY EXAM SKULL COMP, MIN 4V(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
320P0018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$75.77 |
| Rate for Payer: Aetna Commercial |
$73.49
|
| Rate for Payer: Anthem Medicaid |
$39.01
|
| 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 |
$75.77
|
| Rate for Payer: Healthspan PPO |
$68.86
|
| Rate for Payer: Humana Medicaid |
$39.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.01
|
| 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 |
$39.40
|
|
|
XRAY EXAM SKULL COMP, MIN 4V(T
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
320T0018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$440.64 |
| Rate for Payer: Aetna Commercial |
$353.43
|
| Rate for Payer: Anthem Medicaid |
$157.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna Commercial |
$380.97
|
| Rate for Payer: First Health Commercial |
$436.05
|
| Rate for Payer: Humana Commercial |
$390.15
|
| Rate for Payer: Humana KY Medicaid |
$157.85
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$159.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$376.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.92
|
| Rate for Payer: Ohio Health Group HMO |
$344.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.29
|
| Rate for Payer: PHCS Commercial |
$440.64
|
| Rate for Payer: United Healthcare All Payer |
$403.92
|
|
|
XRAY EXAM SKULL COMP, MIN 4V(T
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
320T0018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$440.64 |
| Rate for Payer: Aetna Commercial |
$353.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.02
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna Commercial |
$380.97
|
| Rate for Payer: First Health Commercial |
$436.05
|
| Rate for Payer: Humana Commercial |
$390.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$376.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.92
|
| Rate for Payer: Ohio Health Group HMO |
$344.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.29
|
| Rate for Payer: PHCS Commercial |
$440.64
|
| Rate for Payer: United Healthcare All Payer |
$403.92
|
|
