|
X-RAY EXAM THORACOLMB 2/> V(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
320P0269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$53.72
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$120.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$54.35
|
| Rate for Payer: Healthspan PPO |
$50.34
|
| Rate for Payer: Humana Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.07
|
| Rate for Payer: Molina Healthcare Passport |
$27.52
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.00
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.80
|
|
|
X-RAY EXAM THORACOLMB 2/> V(T
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
320T0269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
X-RAY EXAM THORACOLMB 2/> V(T
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
320T0269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
32000269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$53.72
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$520.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$54.35
|
| Rate for Payer: Healthspan PPO |
$50.34
|
| Rate for Payer: Humana Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.07
|
| Rate for Payer: Molina Healthcare Passport |
$27.52
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.80
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
32000269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
32000269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
X-RAY EXAM THORAC SPINE 2VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
320P0050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Aetna Commercial |
$51.58
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| 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 |
$52.70
|
| Rate for Payer: Healthspan PPO |
$48.33
|
| Rate for Payer: Humana Medicaid |
$26.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.52
|
| Rate for Payer: Molina Healthcare Passport |
$26.98
|
| 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 |
$27.25
|
|
|
X-RAY EXAM THORAC SPINE 2VWS
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$51.58
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| 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 |
$52.70
|
| Rate for Payer: Healthspan PPO |
$48.33
|
| Rate for Payer: Humana Medicaid |
$26.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.52
|
| Rate for Payer: Molina Healthcare Passport |
$26.98
|
| 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 |
$27.25
|
|
|
X-RAY EXAM THORAC SPINE 2VWS
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
32000050
|
|
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 POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
X-RAY EXAM THORAC SPINE 2VWS
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
32000050
|
|
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 |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| 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 |
$95.07
|
| 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 |
$114.08
|
| 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 THORAC SPINE 2VW(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
320T0050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
X-RAY EXAM THORAC SPINE 2VW(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
320T0050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
X-RAY EXAM THORAC SPINE 3VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
320P0268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: Aetna Commercial |
$58.72
|
| Rate for Payer: Anthem Medicaid |
$29.37
|
| 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 |
$58.23
|
| Rate for Payer: Healthspan PPO |
$55.02
|
| Rate for Payer: Humana Medicaid |
$29.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.96
|
| Rate for Payer: Molina Healthcare Passport |
$29.37
|
| 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 |
$29.66
|
|
|
X-RAY EXAM THORAC SPINE 3VWS
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
32000268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna Commercial |
$58.72
|
| Rate for Payer: Anthem Medicaid |
$29.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$531.00
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$58.23
|
| Rate for Payer: Healthspan PPO |
$55.02
|
| Rate for Payer: Humana Medicaid |
$29.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.96
|
| Rate for Payer: Molina Healthcare Passport |
$29.37
|
| Rate for Payer: Multiplan PHCS |
$318.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.70
|
| Rate for Payer: UHCCP Medicaid |
$185.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.66
|
|
|
X-RAY EXAM THORAC SPINE 3VWS
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
32000268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.61
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
X-RAY EXAM THORAC SPINE 3VWS
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
32000268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.61
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
X-RAY EXAM THORAC SPINE 3VW(T
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
320T0268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.53 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.18
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.11
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
X-RAY EXAM THORAC SPINE 3VW(T
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
320T0268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.53 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem Medicaid |
$165.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Humana KY Medicaid |
$165.42
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$167.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.11
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
X-RAY EXAM UNILAT RIBS/CHES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
320P0038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$59.82 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Anthem Medicaid |
$30.03
|
| 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 |
$58.36
|
| Rate for Payer: Healthspan PPO |
$56.06
|
| Rate for Payer: Humana Medicaid |
$30.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.63
|
| Rate for Payer: Molina Healthcare Passport |
$30.03
|
| 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 |
$30.33
|
|
|
X-RAY EXAM UNILAT RIBS/CHES(T
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
320T0038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
X-RAY EXAM UNILAT RIBS/CHES(T
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
320T0038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
X-RAY EXAM UNILAT RIBS/CHEST
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
32000038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
X-RAY EXAM UNILAT RIBS/CHEST
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
32000038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Anthem Medicaid |
$30.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Healthspan PPO |
$56.06
|
| Rate for Payer: Humana Medicaid |
$30.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.63
|
| Rate for Payer: Molina Healthcare Passport |
$30.03
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.33
|
|
|
X-RAY EXAM UNILAT RIBS/CHEST
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
32000038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
X-RAY FOR PANCREAS ENDOSCOP(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
320P0282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
