|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32001021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.53
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32001021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem Medicaid |
$219.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Humana KY Medicaid |
$219.06
|
| Rate for Payer: Kentucky WC Medicaid |
$221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.53
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
XRAY CONTROL CATHETER CHANGE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320P1021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Ambetter Exchange |
$86.02
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.22
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.63
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.83
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.02
|
|
|
XRAY CONTROL CATHETER CHANGE(T
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T1021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$347.52 |
| Rate for Payer: Aetna Commercial |
$278.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$282.36
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$300.46
|
| Rate for Payer: First Health Commercial |
$343.90
|
| Rate for Payer: Humana Commercial |
$307.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$318.56
|
| Rate for Payer: Ohio Health Group HMO |
$271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.78
|
| Rate for Payer: PHCS Commercial |
$347.52
|
| Rate for Payer: United Healthcare All Payer |
$318.56
|
|
|
XRAY CONTROL CATHETER CHANGE(T
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T1021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$347.52 |
| Rate for Payer: Aetna Commercial |
$278.74
|
| Rate for Payer: Anthem Medicaid |
$124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$282.36
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$300.46
|
| Rate for Payer: First Health Commercial |
$343.90
|
| Rate for Payer: Humana Commercial |
$307.70
|
| Rate for Payer: Humana KY Medicaid |
$124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$125.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$318.56
|
| Rate for Payer: Ohio Health Group HMO |
$271.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.78
|
| Rate for Payer: PHCS Commercial |
$347.52
|
| Rate for Payer: United Healthcare All Payer |
$318.56
|
|
|
XRAY CONTROL CATHETER CHANG(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320P0179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Ambetter Exchange |
$86.02
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.22
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.63
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.83
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.02
|
|
|
XRAY CONTROL CATHETER CHANG(T
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T0179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$281.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.88
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
XRAY CONTROL CATHETER CHANG(T
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
320T0179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem Medicaid |
$121.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Humana KY Medicaid |
$121.05
|
| Rate for Payer: Kentucky WC Medicaid |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$281.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.88
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
X-RAY EXAM BREASTBONE 2/>VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
320P0040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Ambetter Exchange |
$30.12
|
| Rate for Payer: Anthem Medicaid |
$26.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.14
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$51.50
|
| Rate for Payer: Healthspan PPO |
$46.76
|
| Rate for Payer: Humana Medicaid |
$26.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.65
|
| Rate for Payer: Molina Healthcare Passport |
$26.13
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.16
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.12
|
|
|
X-RAY EXAM BREASTBONE 2/>VWS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
X-RAY EXAM BREASTBONE 2/>VWS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Humana KY Medicaid |
$138.94
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
X-RAY EXAM BREASTBONE 2/>VWS
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
32000040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$242.40 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Ambetter Exchange |
$30.12
|
| Rate for Payer: Anthem Medicaid |
$26.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.14
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$51.50
|
| Rate for Payer: Healthspan PPO |
$46.76
|
| Rate for Payer: Humana Medicaid |
$26.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.65
|
| Rate for Payer: Molina Healthcare Passport |
$26.13
|
| Rate for Payer: Multiplan PHCS |
$242.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.16
|
| Rate for Payer: UHCCP Medicaid |
$141.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.12
|
|
|
X-RAY EXAM BREASTBONE 2/>VW(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
320T0040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
X-RAY EXAM BREASTBONE 2/>VW(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
320T0040
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.30 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.79
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem Medicaid |
$168.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Humana KY Medicaid |
$168.85
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$170.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.79
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$294.60 |
| Rate for Payer: Ambetter Exchange |
$38.84
|
| Rate for Payer: Anthem Medicaid |
$29.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.61
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$61.00
|
| Rate for Payer: Humana Medicaid |
$29.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.70
|
| Rate for Payer: Molina Healthcare Passport |
$29.12
|
| Rate for Payer: Multiplan PHCS |
$294.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.49
|
| Rate for Payer: UHCCP Medicaid |
$171.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.84
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
320P0051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Ambetter Exchange |
$38.84
|
| Rate for Payer: Anthem Medicaid |
$29.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.61
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$61.00
|
| Rate for Payer: Humana Medicaid |
$29.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.70
|
| Rate for Payer: Molina Healthcare Passport |
$29.12
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.49
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.84
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
320T0051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
X-RAY EXAM ENTIRE SPI 1 VW(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 72081
|
| Hospital Charge Code |
320T0051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 V(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
320P0270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Ambetter Exchange |
$63.19
|
| Rate for Payer: Anthem Medicaid |
$46.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.83
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$97.49
|
| Rate for Payer: Humana Medicaid |
$46.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.32
|
| Rate for Payer: Molina Healthcare Passport |
$46.39
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.15
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.19
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 V(T
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
320T0270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem Medicaid |
$166.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Humana KY Medicaid |
$166.10
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$167.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.27
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 V(T
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
320T0270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.27
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 VW
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
32000270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.90 |
| Max. Negotiated Rate |
$674.88 |
| Rate for Payer: Aetna Commercial |
$541.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$548.34
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$583.49
|
| Rate for Payer: First Health Commercial |
$667.85
|
| Rate for Payer: Humana Commercial |
$597.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$576.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$518.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$618.64
|
| Rate for Payer: Ohio Health Group HMO |
$527.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.07
|
| Rate for Payer: PHCS Commercial |
$674.88
|
| Rate for Payer: United Healthcare All Payer |
$618.64
|
|
|
X-RAY EXAM ENTIRE SPI 2/3 VW
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
32000270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$421.80 |
| Rate for Payer: Ambetter Exchange |
$63.19
|
| Rate for Payer: Anthem Medicaid |
$46.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.83
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cash Price |
$351.50
|
| Rate for Payer: Cigna Commercial |
$97.49
|
| Rate for Payer: Humana Medicaid |
$46.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.32
|
| Rate for Payer: Molina Healthcare Passport |
$46.39
|
| Rate for Payer: Multiplan PHCS |
$421.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.15
|
| Rate for Payer: UHCCP Medicaid |
$246.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.19
|
|
