|
X-RAY EXAM ENTIRE SPI 2/3 VW
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
HCPCS 72082
|
| Hospital Charge Code |
32000270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$674.88 |
| Rate for Payer: Aetna Commercial |
$541.31
|
| Rate for Payer: Anthem Medicaid |
$241.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$548.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$351.50
|
| 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: Humana KY Medicaid |
$241.76
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$244.22
|
| 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 |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$246.61
|
| 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 HIPS BI 2 VIEWS
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$692.16 |
| Rate for Payer: Aetna Commercial |
$555.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$562.38
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$598.43
|
| Rate for Payer: First Health Commercial |
$684.95
|
| Rate for Payer: Humana Commercial |
$612.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$591.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$532.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$634.48
|
| Rate for Payer: Ohio Health Group HMO |
$540.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.49
|
| Rate for Payer: PHCS Commercial |
$692.16
|
| Rate for Payer: United Healthcare All Payer |
$634.48
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS
|
Professional
|
Both
|
$721.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$432.60 |
| Rate for Payer: Ambetter Exchange |
$37.25
|
| Rate for Payer: Anthem Medicaid |
$29.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.70
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$61.93
|
| Rate for Payer: Humana Medicaid |
$29.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.37
|
| Rate for Payer: Molina Healthcare Passport |
$29.77
|
| Rate for Payer: Multiplan PHCS |
$432.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.42
|
| Rate for Payer: UHCCP Medicaid |
$252.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.25
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
32000277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$692.16 |
| Rate for Payer: Aetna Commercial |
$555.17
|
| Rate for Payer: Anthem Medicaid |
$247.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$562.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cigna Commercial |
$598.43
|
| Rate for Payer: First Health Commercial |
$684.95
|
| Rate for Payer: Humana Commercial |
$612.85
|
| Rate for Payer: Humana KY Medicaid |
$247.95
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$250.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$591.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$532.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$252.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$634.48
|
| Rate for Payer: Ohio Health Group HMO |
$540.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.49
|
| Rate for Payer: PHCS Commercial |
$692.16
|
| Rate for Payer: United Healthcare All Payer |
$634.48
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
320P0277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Ambetter Exchange |
$37.25
|
| Rate for Payer: Anthem Medicaid |
$29.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.70
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$61.93
|
| Rate for Payer: Humana Medicaid |
$29.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.37
|
| Rate for Payer: Molina Healthcare Passport |
$29.77
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.42
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.25
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS(T
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
320T0277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
X-RAY EXAM HIPS BI 2 VIEWS(T
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
320T0277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.30 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEW(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
320P0278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Ambetter Exchange |
$48.65
|
| Rate for Payer: Anthem Medicaid |
$36.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.38
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$76.51
|
| Rate for Payer: Humana Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.21
|
| Rate for Payer: Molina Healthcare Passport |
$36.48
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.24
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.65
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
32000278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$457.80 |
| Rate for Payer: Ambetter Exchange |
$48.65
|
| Rate for Payer: Anthem Medicaid |
$36.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.38
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$76.51
|
| Rate for Payer: Humana Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.21
|
| Rate for Payer: Molina Healthcare Passport |
$36.48
|
| Rate for Payer: Multiplan PHCS |
$457.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.24
|
| Rate for Payer: UHCCP Medicaid |
$267.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.65
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
32000278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
32000278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.90 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEW(T
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
320T0278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem Medicaid |
$190.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Humana KY Medicaid |
$190.18
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$192.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
X-RAY EXAM HIPS BI 3-4 VIEW(T
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
320T0278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.90 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
X-RAY EXAM HIPS BI 5/> VIEW(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
320P0096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Ambetter Exchange |
$55.82
|
| Rate for Payer: Anthem Medicaid |
$42.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.98
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$88.69
|
| Rate for Payer: Humana Medicaid |
$42.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.09
|
| Rate for Payer: Molina Healthcare Passport |
$42.25
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.57
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.82
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
32000096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$481.20 |
| Rate for Payer: Ambetter Exchange |
$55.82
|
| Rate for Payer: Anthem Medicaid |
$42.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.98
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cigna Commercial |
$88.69
|
| Rate for Payer: Humana Medicaid |
$42.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.09
|
| Rate for Payer: Molina Healthcare Passport |
$42.25
|
| Rate for Payer: Multiplan PHCS |
$481.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.57
|
| Rate for Payer: UHCCP Medicaid |
$280.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.82
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
32000096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.60 |
| Max. Negotiated Rate |
$769.92 |
| Rate for Payer: Aetna Commercial |
$617.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.56
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cigna Commercial |
$665.66
|
| Rate for Payer: First Health Commercial |
$761.90
|
| Rate for Payer: Humana Commercial |
$681.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$657.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$705.76
|
| Rate for Payer: Ohio Health Group HMO |
$601.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.38
|
| Rate for Payer: PHCS Commercial |
$769.92
|
| Rate for Payer: United Healthcare All Payer |
$705.76
|
|
|
X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
32000096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$769.92 |
| Rate for Payer: Aetna Commercial |
$617.54
|
| Rate for Payer: Anthem Medicaid |
$275.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cigna Commercial |
$665.66
|
| Rate for Payer: First Health Commercial |
$761.90
|
| Rate for Payer: Humana Commercial |
$681.70
|
| Rate for Payer: Humana KY Medicaid |
$275.81
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$278.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$657.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$705.76
|
| Rate for Payer: Ohio Health Group HMO |
$601.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.38
|
| Rate for Payer: PHCS Commercial |
$769.92
|
| Rate for Payer: United Healthcare All Payer |
$705.76
|
|
|
X-RAY EXAM HIPS BI 5/> VIEW(T
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
320T0096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.60 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.96
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$483.06
|
| Rate for Payer: First Health Commercial |
$552.90
|
| Rate for Payer: Humana Commercial |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.16
|
| Rate for Payer: Ohio Health Group HMO |
$436.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.58
|
| Rate for Payer: PHCS Commercial |
$558.72
|
| Rate for Payer: United Healthcare All Payer |
$512.16
|
|
|
X-RAY EXAM HIPS BI 5/> VIEW(T
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
320T0096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Anthem Medicaid |
$200.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$483.06
|
| Rate for Payer: First Health Commercial |
$552.90
|
| Rate for Payer: Humana Commercial |
$494.70
|
| Rate for Payer: Humana KY Medicaid |
$200.15
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$202.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.16
|
| Rate for Payer: Ohio Health Group HMO |
$436.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.58
|
| Rate for Payer: PHCS Commercial |
$558.72
|
| Rate for Payer: United Healthcare All Payer |
$512.16
|
|
|
X-RAY EXAM HIP UNI 4/> VIEW(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
320P0276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Ambetter Exchange |
$54.53
|
| Rate for Payer: Anthem Medicaid |
$38.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.44
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$80.84
|
| Rate for Payer: Humana Medicaid |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.24
|
| Rate for Payer: Molina Healthcare Passport |
$38.47
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.89
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.53
|
|
|
X-RAY EXAM HIP UNI 4/> VIEWS
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
32000276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$685.44 |
| Rate for Payer: Aetna Commercial |
$549.78
|
| Rate for Payer: Anthem Medicaid |
$245.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$592.62
|
| Rate for Payer: First Health Commercial |
$678.30
|
| Rate for Payer: Humana Commercial |
$606.90
|
| Rate for Payer: Humana KY Medicaid |
$245.54
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$248.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$585.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$628.32
|
| Rate for Payer: Ohio Health Group HMO |
$535.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.66
|
| Rate for Payer: PHCS Commercial |
$685.44
|
| Rate for Payer: United Healthcare All Payer |
$628.32
|
|
|
X-RAY EXAM HIP UNI 4/> VIEWS
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
32000276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$685.44 |
| Rate for Payer: Aetna Commercial |
$549.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.92
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$592.62
|
| Rate for Payer: First Health Commercial |
$678.30
|
| Rate for Payer: Humana Commercial |
$606.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$585.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$628.32
|
| Rate for Payer: Ohio Health Group HMO |
$535.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.66
|
| Rate for Payer: PHCS Commercial |
$685.44
|
| Rate for Payer: United Healthcare All Payer |
$628.32
|
|
|
X-RAY EXAM HIP UNI 4/> VIEWS
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
32000276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Ambetter Exchange |
$54.53
|
| Rate for Payer: Anthem Medicaid |
$38.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.44
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$80.84
|
| Rate for Payer: Humana Medicaid |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.24
|
| Rate for Payer: Molina Healthcare Passport |
$38.47
|
| Rate for Payer: Multiplan PHCS |
$428.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.89
|
| Rate for Payer: UHCCP Medicaid |
$249.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.53
|
|
|
X-RAY EXAM HIP UNI 4/> VIEW(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
320T0276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.31
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
X-RAY EXAM HIP UNI 4/> VIEW(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
320T0276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.31
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
