|
X-RAY EXAM L-S SPINE BENDING
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Aetna Commercial |
$106.23
|
| Rate for Payer: Ambetter Exchange |
$55.20
|
| Rate for Payer: Anthem Medicaid |
$47.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.24
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$98.42
|
| Rate for Payer: Healthspan PPO |
$99.53
|
| Rate for Payer: Humana Medicaid |
$47.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.57
|
| Rate for Payer: Molina Healthcare Passport |
$47.62
|
| Rate for Payer: Multiplan PHCS |
$264.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.76
|
| Rate for Payer: UHCCP Medicaid |
$154.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.20
|
|
|
X-RAY EXAM L-S SPINE BENDING
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.98
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$366.03
|
| Rate for Payer: First Health Commercial |
$418.95
|
| Rate for Payer: Humana Commercial |
$374.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$325.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.08
|
| Rate for Payer: Ohio Health Group HMO |
$330.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.29
|
| Rate for Payer: PHCS Commercial |
$423.36
|
| Rate for Payer: United Healthcare All Payer |
$388.08
|
|
|
X-RAY EXAM L-S SPINE BENDING
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
32000054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Anthem Medicaid |
$151.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$366.03
|
| Rate for Payer: First Health Commercial |
$418.95
|
| Rate for Payer: Humana Commercial |
$374.85
|
| Rate for Payer: Humana KY Medicaid |
$151.66
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$153.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$325.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.08
|
| Rate for Payer: Ohio Health Group HMO |
$330.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.29
|
| Rate for Payer: PHCS Commercial |
$423.36
|
| Rate for Payer: United Healthcare All Payer |
$388.08
|
|
|
X-RAY EXAM L-S SPINE BENDIN(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
320P0054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$106.23 |
| Rate for Payer: Aetna Commercial |
$106.23
|
| Rate for Payer: Ambetter Exchange |
$55.20
|
| Rate for Payer: Anthem Medicaid |
$47.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.24
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$98.42
|
| Rate for Payer: Healthspan PPO |
$99.53
|
| Rate for Payer: Humana Medicaid |
$47.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.57
|
| Rate for Payer: Molina Healthcare Passport |
$47.62
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.76
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.20
|
|
|
X-RAY EXAM L-S SPINE BENDIN(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
320T0054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
X-RAY EXAM L-S SPINE BENDIN(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
320T0054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
X-RAY EXAM OF ARM INFANT
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
X-RAY EXAM OF ARM INFANT
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
X-RAY EXAM OF ARM INFANT
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
32000083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Ambetter Exchange |
$28.24
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.89
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.24
|
|
|
X-RAY EXAM OF ARM INFANT(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
320P0083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Ambetter Exchange |
$28.24
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.89
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.24
|
|
|
X-RAY EXAM OF ARM INFANT(T
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
320T0083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
X-RAY EXAM OF ARM INFANT(T
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
320T0083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$117.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$117.27
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$118.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
X-RAY EXAM OF KNEES
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
32000102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$312.96 |
| Rate for Payer: Aetna Commercial |
$251.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.28
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cigna Commercial |
$270.58
|
| Rate for Payer: First Health Commercial |
$309.70
|
| Rate for Payer: Humana Commercial |
$277.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.88
|
| Rate for Payer: Ohio Health Group HMO |
$244.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.94
|
| Rate for Payer: PHCS Commercial |
$312.96
|
| Rate for Payer: United Healthcare All Payer |
$286.88
|
|
|
X-RAY EXAM OF KNEES
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
32000102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$195.60 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Ambetter Exchange |
$35.90
|
| Rate for Payer: Anthem Medicaid |
$20.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.08
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cigna Commercial |
$42.90
|
| Rate for Payer: Healthspan PPO |
$42.28
|
| Rate for Payer: Humana Medicaid |
$20.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.85
|
| Rate for Payer: Molina Healthcare Passport |
$20.44
|
| Rate for Payer: Multiplan PHCS |
$195.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.67
|
| Rate for Payer: UHCCP Medicaid |
$114.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.90
|
|
|
X-RAY EXAM OF KNEES
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
32000102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$312.96 |
| Rate for Payer: Aetna Commercial |
$251.02
|
| Rate for Payer: Anthem Medicaid |
$112.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cigna Commercial |
$270.58
|
| Rate for Payer: First Health Commercial |
$309.70
|
| Rate for Payer: Humana Commercial |
$277.10
|
| Rate for Payer: Humana KY Medicaid |
$112.11
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$113.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.88
|
| Rate for Payer: Ohio Health Group HMO |
$244.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.94
|
| Rate for Payer: PHCS Commercial |
$312.96
|
| Rate for Payer: United Healthcare All Payer |
$286.88
|
|
|
X-RAY EXAM OF KNEES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
320P0102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Ambetter Exchange |
$35.90
|
| Rate for Payer: Anthem Medicaid |
$20.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.08
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$42.90
|
| Rate for Payer: Healthspan PPO |
$42.28
|
| Rate for Payer: Humana Medicaid |
$20.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.85
|
| Rate for Payer: Molina Healthcare Passport |
$20.44
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.67
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.90
|
|
|
X-RAY EXAM OF KNEES(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
320T0102
|
|
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 OF KNEES(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
320T0102
|
|
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 OF LEG INFANT
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
X-RAY EXAM OF LEG INFANT
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
X-RAY EXAM OF LEG INFANT
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
32000105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Ambetter Exchange |
$28.24
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.89
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.24
|
|
|
X-RAY EXAM OF LEG INFANT(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
320P0105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Ambetter Exchange |
$28.24
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.89
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.24
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.24
|
|
|
X-RAY EXAM OF LEG INFANT(T
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
320T0105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$117.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$117.27
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$118.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
X-RAY EXAM OF LEG INFANT(T
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
320T0105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
X-RAY EXAM OF NECK
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.61
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
