|
X-RAY FOR PANCREAS ENDOSCOP(T
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
320T0282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.93 |
| Max. Negotiated Rate |
$1,114.56 |
| Rate for Payer: Aetna Commercial |
$893.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$905.58
|
| Rate for Payer: Cash Price |
$580.50
|
| Rate for Payer: Cigna Commercial |
$963.63
|
| Rate for Payer: First Health Commercial |
$1,102.95
|
| Rate for Payer: Humana Commercial |
$986.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,021.68
|
| Rate for Payer: Ohio Health Group HMO |
$870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.91
|
| Rate for Payer: PHCS Commercial |
$1,114.56
|
| Rate for Payer: United Healthcare All Payer |
$1,021.68
|
|
|
X-RAY FOR PANCREAS ENDOSCOP(T
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
320T0282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.93 |
| Max. Negotiated Rate |
$1,114.56 |
| Rate for Payer: Aetna Commercial |
$893.97
|
| Rate for Payer: Anthem Medicaid |
$399.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$905.58
|
| Rate for Payer: Cash Price |
$580.50
|
| Rate for Payer: Cigna Commercial |
$963.63
|
| Rate for Payer: First Health Commercial |
$1,102.95
|
| Rate for Payer: Humana Commercial |
$986.85
|
| Rate for Payer: Humana KY Medicaid |
$399.27
|
| Rate for Payer: Kentucky WC Medicaid |
$403.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$407.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,021.68
|
| Rate for Payer: Ohio Health Group HMO |
$870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.91
|
| Rate for Payer: PHCS Commercial |
$1,114.56
|
| Rate for Payer: United Healthcare All Payer |
$1,021.68
|
|
|
X-RAY FOR PANCREAS ENDOSCOPY
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$1,361.00 |
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,361.00
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| 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 |
$816.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$952.70
|
| Rate for Payer: UHCCP Medicaid |
$476.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY FOR PANCREAS ENDOSCOPY
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.93 |
| Max. Negotiated Rate |
$1,306.56 |
| Rate for Payer: Aetna Commercial |
$1,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,061.58
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$1,129.63
|
| Rate for Payer: First Health Commercial |
$1,292.95
|
| Rate for Payer: Humana Commercial |
$1,156.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,116.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,004.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,197.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.91
|
| Rate for Payer: PHCS Commercial |
$1,306.56
|
| Rate for Payer: United Healthcare All Payer |
$1,197.68
|
|
|
X-RAY FOR PANCREAS ENDOSCOPY
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.93 |
| Max. Negotiated Rate |
$1,306.56 |
| Rate for Payer: Aetna Commercial |
$1,047.97
|
| Rate for Payer: Anthem Medicaid |
$468.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,061.58
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$1,129.63
|
| Rate for Payer: First Health Commercial |
$1,292.95
|
| Rate for Payer: Humana Commercial |
$1,156.85
|
| Rate for Payer: Humana KY Medicaid |
$468.05
|
| Rate for Payer: Kentucky WC Medicaid |
$472.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,116.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,004.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,197.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.91
|
| Rate for Payer: PHCS Commercial |
$1,306.56
|
| Rate for Payer: United Healthcare All Payer |
$1,197.68
|
|
|
X-RAY OF LOWER SPINE DISK
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$552.24 |
| Max. Negotiated Rate |
$4,078.08 |
| Rate for Payer: Aetna Commercial |
$3,270.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.44
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$3,525.84
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Humana Commercial |
$3,610.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.88
|
| Rate for Payer: PHCS Commercial |
$4,078.08
|
| Rate for Payer: United Healthcare All Payer |
$3,738.24
|
|
|
X-RAY OF LOWER SPINE DISK
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$552.24 |
| Max. Negotiated Rate |
$4,078.08 |
| Rate for Payer: Aetna Commercial |
$3,270.96
|
| Rate for Payer: Anthem Medicaid |
$1,460.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$3,525.84
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Humana Commercial |
$3,610.80
|
| Rate for Payer: Humana KY Medicaid |
$1,460.89
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.88
|
| Rate for Payer: PHCS Commercial |
$4,078.08
|
| Rate for Payer: United Healthcare All Payer |
$3,738.24
|
|
|
X-RAY OF LOWER SPINE DISK
|
Professional
|
Both
|
$4,248.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Healthspan PPO |
$232.53
|
| Rate for Payer: Aetna Commercial |
$248.16
|
| Rate for Payer: Anthem Medicaid |
$248.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,248.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$425.48
|
| Rate for Payer: Humana Medicaid |
$248.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.04
|
| Rate for Payer: Molina Healthcare Passport |
$248.08
|
| Rate for Payer: Multiplan PHCS |
$2,548.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,973.60
|
| Rate for Payer: UHCCP Medicaid |
$1,486.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.56
|
|
|
X-RAY OF LOWER SPINE DISK(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
320P0071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$425.48 |
| Rate for Payer: Aetna Commercial |
$248.16
|
| Rate for Payer: Anthem Medicaid |
$248.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$425.48
|
| Rate for Payer: Healthspan PPO |
$232.53
|
| Rate for Payer: Humana Medicaid |
$248.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.04
|
| Rate for Payer: Molina Healthcare Passport |
$248.08
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.56
|
|
|
X-RAY OF LOWER SPINE DISK(T
|
Facility
|
IP
|
$3,973.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
320T0071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$516.49 |
| Max. Negotiated Rate |
$3,814.08 |
| Rate for Payer: Aetna Commercial |
$3,059.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.94
|
| Rate for Payer: Cash Price |
$1,986.50
|
| Rate for Payer: Cigna Commercial |
$3,297.59
|
| Rate for Payer: First Health Commercial |
$3,774.35
|
| Rate for Payer: Humana Commercial |
$3,377.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,932.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,496.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.63
|
| Rate for Payer: PHCS Commercial |
$3,814.08
|
| Rate for Payer: United Healthcare All Payer |
$3,496.24
|
|
|
X-RAY OF LOWER SPINE DISK(T
|
Facility
|
OP
|
$3,973.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
320T0071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$516.49 |
| Max. Negotiated Rate |
$3,814.08 |
| Rate for Payer: Aetna Commercial |
$3,059.21
|
| Rate for Payer: Anthem Medicaid |
$1,366.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$1,986.50
|
| Rate for Payer: Cash Price |
$1,986.50
|
| Rate for Payer: Cigna Commercial |
$3,297.59
|
| Rate for Payer: First Health Commercial |
$3,774.35
|
| Rate for Payer: Humana Commercial |
$3,377.05
|
| Rate for Payer: Humana KY Medicaid |
$1,366.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,380.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,932.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,496.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.63
|
| Rate for Payer: PHCS Commercial |
$3,814.08
|
| Rate for Payer: United Healthcare All Payer |
$3,496.24
|
|
|
X-RAYS BONE LENGTH STUDIES
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Anthem Medicaid |
$29.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$336.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Healthspan PPO |
$54.21
|
| Rate for Payer: Humana Medicaid |
$29.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.45
|
| Rate for Payer: Molina Healthcare Passport |
$29.85
|
| Rate for Payer: Multiplan PHCS |
$201.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.20
|
| Rate for Payer: UHCCP Medicaid |
$117.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.15
|
|
|
X-RAYS BONE LENGTH STUDIES
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.08
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.16
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
X-RAYS BONE LENGTH STUDIES
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$322.56 |
| Rate for Payer: Aetna Commercial |
$258.72
|
| Rate for Payer: Anthem Medicaid |
$115.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$278.88
|
| Rate for Payer: First Health Commercial |
$319.20
|
| Rate for Payer: Humana Commercial |
$285.60
|
| Rate for Payer: Humana KY Medicaid |
$115.55
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$116.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$275.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$295.68
|
| Rate for Payer: Ohio Health Group HMO |
$252.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.16
|
| Rate for Payer: PHCS Commercial |
$322.56
|
| Rate for Payer: United Healthcare All Payer |
$295.68
|
|
|
X-RAYS BONE LENGTH STUDIES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
320P0235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Anthem Medicaid |
$29.85
|
| 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 |
$62.24
|
| Rate for Payer: Healthspan PPO |
$54.21
|
| Rate for Payer: Humana Medicaid |
$29.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.45
|
| Rate for Payer: Molina Healthcare Passport |
$29.85
|
| 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 |
$30.15
|
|
|
X-RAYS BONE LENGTH STUDIES(T
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
320T0235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
X-RAYS BONE LENGTH STUDIES(T
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
320T0235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem Medicaid |
$98.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Humana KY Medicaid |
$98.36
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$99.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
X-RAYS BONE SURVEY LIMITED
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$746.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Anthem Medicaid |
$45.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$746.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$94.33
|
| Rate for Payer: Healthspan PPO |
$98.38
|
| Rate for Payer: Humana Medicaid |
$45.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.34
|
| Rate for Payer: Molina Healthcare Passport |
$45.43
|
| Rate for Payer: Multiplan PHCS |
$447.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.20
|
| Rate for Payer: UHCCP Medicaid |
$261.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.88
|
|
|
X-RAYS BONE SURVEY LIMITED
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.26
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
X-RAYS BONE SURVEY LIMITED
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem Medicaid |
$256.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Humana KY Medicaid |
$256.55
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$259.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.26
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
X-RAYS BONE SURVEY LIMITED(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
320P0294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Anthem Medicaid |
$45.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$94.33
|
| Rate for Payer: Healthspan PPO |
$98.38
|
| Rate for Payer: Humana Medicaid |
$45.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.34
|
| Rate for Payer: Molina Healthcare Passport |
$45.43
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.88
|
|
|
X-RAYS BONE SURVEY LIMITED(T
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
320T0294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem Medicaid |
$204.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Humana KY Medicaid |
$204.96
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$207.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$209.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.76
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
|
X-RAYS BONE SURVEY LIMITED(T
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
320T0294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.88
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.76
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
|
X-RAY STRENOCLAVIC JT 3/>VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
320P0041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Anthem Medicaid |
$28.32
|
| 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 |
$57.11
|
| Rate for Payer: Healthspan PPO |
$53.36
|
| Rate for Payer: Humana Medicaid |
$28.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.89
|
| Rate for Payer: Molina Healthcare Passport |
$28.32
|
| 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 |
$28.60
|
|
|
X-RAY STRENOCLAVIC JT 3/>VWS
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Anthem Medicaid |
$28.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$57.11
|
| Rate for Payer: Healthspan PPO |
$53.36
|
| Rate for Payer: Humana Medicaid |
$28.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.89
|
| Rate for Payer: Molina Healthcare Passport |
$28.32
|
| Rate for Payer: Multiplan PHCS |
$268.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$313.60
|
| Rate for Payer: UHCCP Medicaid |
$156.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.60
|
|
