|
X-RAY STRENOCLAVIC JT 3/>VWS
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$430.08 |
| Rate for Payer: Aetna Commercial |
$344.96
|
| Rate for Payer: Anthem Medicaid |
$154.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$371.84
|
| Rate for Payer: First Health Commercial |
$425.60
|
| Rate for Payer: Humana Commercial |
$380.80
|
| Rate for Payer: Humana KY Medicaid |
$154.07
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$155.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$367.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$330.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.24
|
| Rate for Payer: Ohio Health Group HMO |
$336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.88
|
| Rate for Payer: PHCS Commercial |
$430.08
|
| Rate for Payer: United Healthcare All Payer |
$394.24
|
|
|
X-RAY STRENOCLAVIC JT 3/>VWS
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$430.08 |
| Rate for Payer: Aetna Commercial |
$344.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$349.44
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$371.84
|
| Rate for Payer: First Health Commercial |
$425.60
|
| Rate for Payer: Humana Commercial |
$380.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$367.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$330.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.24
|
| Rate for Payer: Ohio Health Group HMO |
$336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.88
|
| Rate for Payer: PHCS Commercial |
$430.08
|
| Rate for Payer: United Healthcare All Payer |
$394.24
|
|
|
X-RAY STRENOCLAVIC JT 3/>VW(T
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
320T0041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$382.08 |
| Rate for Payer: Aetna Commercial |
$306.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.44
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$330.34
|
| Rate for Payer: First Health Commercial |
$378.10
|
| Rate for Payer: Humana Commercial |
$338.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$326.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$293.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$350.24
|
| Rate for Payer: Ohio Health Group HMO |
$298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.38
|
| Rate for Payer: PHCS Commercial |
$382.08
|
| Rate for Payer: United Healthcare All Payer |
$350.24
|
|
|
X-RAY STRENOCLAVIC JT 3/>VW(T
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
320T0041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$382.08 |
| Rate for Payer: Aetna Commercial |
$306.46
|
| Rate for Payer: Anthem Medicaid |
$136.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$330.34
|
| Rate for Payer: First Health Commercial |
$378.10
|
| Rate for Payer: Humana Commercial |
$338.30
|
| Rate for Payer: Humana KY Medicaid |
$136.87
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$138.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$326.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$293.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$350.24
|
| Rate for Payer: Ohio Health Group HMO |
$298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.38
|
| Rate for Payer: PHCS Commercial |
$382.08
|
| Rate for Payer: United Healthcare All Payer |
$350.24
|
|
|
X-RAY STRESS VIEW
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Humana KY Medicaid |
$150.28
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.47
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
X-RAY STRESS VIEW
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.47
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
X-RAY STRESS VIEW
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Anthem Medicaid |
$21.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$437.00
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$43.45
|
| Rate for Payer: Healthspan PPO |
$57.27
|
| Rate for Payer: Humana Medicaid |
$21.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.13
|
| Rate for Payer: Molina Healthcare Passport |
$21.70
|
| Rate for Payer: Multiplan PHCS |
$262.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$305.90
|
| Rate for Payer: UHCCP Medicaid |
$152.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.92
|
|
|
X-RAY STRESS VIEW(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
320P0293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Anthem Medicaid |
$21.70
|
| 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 |
$43.45
|
| Rate for Payer: Healthspan PPO |
$57.27
|
| Rate for Payer: Humana Medicaid |
$21.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.13
|
| Rate for Payer: Molina Healthcare Passport |
$21.70
|
| 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 |
$21.92
|
|
|
X-RAY STRESS VIEW(T
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
320T0293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.97
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
X-RAY STRESS VIEW(T
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
320T0293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.97
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
X-RAY UPPER GI DELAY W/O KUB
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$644.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.86
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$694.71
|
| Rate for Payer: First Health Commercial |
$795.15
|
| Rate for Payer: Humana Commercial |
$711.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.56
|
| Rate for Payer: Ohio Health Group HMO |
$627.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.47
|
| Rate for Payer: PHCS Commercial |
$803.52
|
| Rate for Payer: United Healthcare All Payer |
$736.56
|
|
|
X-RAY UPPER GI DELAY W/O KUB
|
Professional
|
Both
|
$837.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Aetna Commercial |
$162.74
|
| Rate for Payer: Anthem Medicaid |
$90.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$837.00
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$142.09
|
| Rate for Payer: Healthspan PPO |
$152.49
|
| Rate for Payer: Humana Medicaid |
$90.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.28
|
| Rate for Payer: Molina Healthcare Passport |
$90.47
|
| Rate for Payer: Multiplan PHCS |
$502.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$585.90
|
| Rate for Payer: UHCCP Medicaid |
$292.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.37
|
|
|
X-RAY UPPER GI DELAY W/O KUB
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$644.49
|
| Rate for Payer: Anthem Medicaid |
$287.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$694.71
|
| Rate for Payer: First Health Commercial |
$795.15
|
| Rate for Payer: Humana Commercial |
$711.45
|
| Rate for Payer: Humana KY Medicaid |
$287.84
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$290.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.56
|
| Rate for Payer: Ohio Health Group HMO |
$627.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.47
|
| Rate for Payer: PHCS Commercial |
$803.52
|
| Rate for Payer: United Healthcare All Payer |
$736.56
|
|
|
X-RAY UPPER GI DELAY W/O KU(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
320P0131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$162.74
|
| Rate for Payer: Anthem Medicaid |
$90.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$142.09
|
| Rate for Payer: Healthspan PPO |
$152.49
|
| Rate for Payer: Humana Medicaid |
$90.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.28
|
| Rate for Payer: Molina Healthcare Passport |
$90.47
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.37
|
|
|
X-RAY UPPER GI DELAY W/O KU(T
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
320T0131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.22
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
X-RAY UPPER GI DELAY W/O KU(T
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
320T0131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem Medicaid |
$227.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Humana KY Medicaid |
$227.66
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$229.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.22
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
X-RAY URETHRA/BLADDER
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
32001022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$955.00 |
| Rate for Payer: Aetna Commercial |
$115.02
|
| Rate for Payer: Anthem Medicaid |
$53.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.00
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$109.96
|
| Rate for Payer: Healthspan PPO |
$236.13
|
| Rate for Payer: Humana Medicaid |
$53.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.73
|
| Rate for Payer: Molina Healthcare Passport |
$53.66
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.50
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.20
|
|
|
X-RAY URETHRA/BLADDER
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
32001022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.05
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
X-RAY URETHRA/BLADDER
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
32001022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem Medicaid |
$328.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Humana KY Medicaid |
$328.42
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.05
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
X-RAY URETHRA/BLADDER (P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
320P1022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$236.13 |
| Rate for Payer: Aetna Commercial |
$115.02
|
| Rate for Payer: Anthem Medicaid |
$53.66
|
| 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 |
$109.96
|
| Rate for Payer: Healthspan PPO |
$236.13
|
| Rate for Payer: Humana Medicaid |
$53.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.73
|
| Rate for Payer: Molina Healthcare Passport |
$53.66
|
| 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 |
$54.20
|
|
|
X-RAY URETHRA/BLADDER (T
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
320T1022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
X-RAY URETHRA/BLADDER (T
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
320T1022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
XYLCN2%+EPNEPHRIN1:200KMPF10ML
|
Facility
|
OP
|
$117.27
|
|
|
Service Code
|
NDC 63323048901
|
| Hospital Charge Code |
25003733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$90.30
|
| Rate for Payer: Anthem Medicaid |
$40.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.47
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: First Health Commercial |
$111.41
|
| Rate for Payer: Humana Commercial |
$99.68
|
| Rate for Payer: Humana KY Medicaid |
$40.33
|
| Rate for Payer: Kentucky WC Medicaid |
$40.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.20
|
| Rate for Payer: Ohio Health Group HMO |
$87.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.35
|
| Rate for Payer: PHCS Commercial |
$112.58
|
| Rate for Payer: United Healthcare All Payer |
$103.20
|
|
|
XYLCN2%+EPNEPHRIN1:200KMPF10ML
|
Facility
|
IP
|
$117.27
|
|
|
Service Code
|
NDC 63323048901
|
| Hospital Charge Code |
25003733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$90.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.47
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: First Health Commercial |
$111.41
|
| Rate for Payer: Humana Commercial |
$99.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.20
|
| Rate for Payer: Ohio Health Group HMO |
$87.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.35
|
| Rate for Payer: PHCS Commercial |
$112.58
|
| Rate for Payer: United Healthcare All Payer |
$103.20
|
|
|
XYLOCAINE 1%+ EPI 1:100K(10ML)
|
Facility
|
IP
|
$79.47
|
|
|
Service Code
|
NDC 63323048201
|
| Hospital Charge Code |
25003619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$76.29 |
| Rate for Payer: Aetna Commercial |
$61.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cigna Commercial |
$65.96
|
| Rate for Payer: First Health Commercial |
$75.50
|
| Rate for Payer: Humana Commercial |
$67.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.93
|
| Rate for Payer: Ohio Health Group HMO |
$59.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.64
|
| Rate for Payer: PHCS Commercial |
$76.29
|
| Rate for Payer: United Healthcare All Payer |
$69.93
|
|
