|
X-RAY EXAM OF NECK
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$281.40 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: Ambetter Exchange |
$28.30
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.96
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$38.14
|
| Rate for Payer: Healthspan PPO |
$38.28
|
| Rate for Payer: Humana Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.21
|
| Rate for Payer: Molina Healthcare Passport |
$18.83
|
| Rate for Payer: Multiplan PHCS |
$281.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.79
|
| Rate for Payer: UHCCP Medicaid |
$164.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.30
|
|
|
X-RAY EXAM OF NECK
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
32000019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem Medicaid |
$161.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$234.50
|
| 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: Humana KY Medicaid |
$161.29
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$162.93
|
| 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 |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.53
|
| 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
|
|
|
X-RAY EXAM OF NECK(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
320P0019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$40.85
|
| Rate for Payer: Ambetter Exchange |
$28.30
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.96
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$38.14
|
| Rate for Payer: Healthspan PPO |
$38.28
|
| Rate for Payer: Humana Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.21
|
| Rate for Payer: Molina Healthcare Passport |
$18.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.79
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.30
|
|
|
X-RAY EXAM OF NECK(T
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
320T0019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem Medicaid |
$147.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Humana KY Medicaid |
$147.53
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$149.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
X-RAY EXAM OF NECK(T
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
320T0019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
X-RAY EXAM OF SALIVARY DUCT
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem Medicaid |
$329.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Humana KY Medicaid |
$329.11
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$332.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$832.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.33
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
X-RAY EXAM OF SALIVARY DUCT
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.10 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$832.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.33
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
X-RAY EXAM OF SALIVARY DUCT
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Ambetter Exchange |
$101.11
|
| Rate for Payer: Anthem Medicaid |
$64.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.33
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$136.61
|
| Rate for Payer: Healthspan PPO |
$140.55
|
| Rate for Payer: Humana Medicaid |
$64.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.00
|
| Rate for Payer: Molina Healthcare Passport |
$64.71
|
| Rate for Payer: Multiplan PHCS |
$574.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.44
|
| Rate for Payer: UHCCP Medicaid |
$334.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.11
|
|
|
X-RAY EXAM OF SALIVARY DUCT(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
320P0267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Ambetter Exchange |
$101.11
|
| Rate for Payer: Anthem Medicaid |
$64.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.33
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$136.61
|
| Rate for Payer: Healthspan PPO |
$140.55
|
| Rate for Payer: Humana Medicaid |
$64.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.00
|
| Rate for Payer: Molina Healthcare Passport |
$64.71
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.44
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.11
|
|
|
X-RAY EXAM OF SALIVARY DUCT(T
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
320T0267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$846.72 |
| Rate for Payer: Aetna Commercial |
$679.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$687.96
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$732.06
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: Humana Commercial |
$749.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$723.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$776.16
|
| Rate for Payer: Ohio Health Group HMO |
$661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$705.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$767.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.58
|
| Rate for Payer: PHCS Commercial |
$846.72
|
| Rate for Payer: United Healthcare All Payer |
$776.16
|
|
|
X-RAY EXAM OF SALIVARY DUCT(T
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
HCPCS 70390
|
| Hospital Charge Code |
320T0267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$846.72 |
| Rate for Payer: Aetna Commercial |
$679.14
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$687.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$732.06
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: Humana Commercial |
$749.70
|
| Rate for Payer: Humana KY Medicaid |
$303.32
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$306.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$723.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$309.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$776.16
|
| Rate for Payer: Ohio Health Group HMO |
$661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$705.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$767.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.58
|
| Rate for Payer: PHCS Commercial |
$846.72
|
| Rate for Payer: United Healthcare All Payer |
$776.16
|
|
|
X-RAY EXAM OF SHOULDER BLADE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
X-RAY EXAM OF SHOULDER BLADE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
X-RAY EXAM OF SHOULDER BLADE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
32000073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Ambetter Exchange |
$21.79
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.15
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$42.53
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$196.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.33
|
| Rate for Payer: UHCCP Medicaid |
$114.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.79
|
|
|
X-RAY EXAM OF SHOULDER BLAD(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
320P0073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Ambetter Exchange |
$21.79
|
| Rate for Payer: Anthem Medicaid |
$21.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.15
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$42.53
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$21.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare Passport |
$21.52
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.33
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.79
|
|
|
X-RAY EXAM OF SHOULDER BLAD(T
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
320T0073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem Medicaid |
$95.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Humana KY Medicaid |
$95.26
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$96.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
X-RAY EXAM OF SHOULDER BLAD(T
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
320T0073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
X-RAY EXAM OFSHOULDER MIN 2(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
320P0075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Ambetter Exchange |
$31.24
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.49
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.92
|
| Rate for Payer: Healthspan PPO |
$42.66
|
| Rate for Payer: Humana Medicaid |
$23.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.59
|
| Rate for Payer: Molina Healthcare Passport |
$23.13
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.61
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.24
|
|
|
X-RAY EXAM OFSHOULDER MIN 2(T
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
320T0075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$129.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$129.99
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$131.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
X-RAY EXAM OFSHOULDER MIN 2(T
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
320T0075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
X-RAY EXAM OFSHOULDER MIN 2V
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$415.68 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Anthem Medicaid |
$148.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$359.39
|
| Rate for Payer: First Health Commercial |
$411.35
|
| Rate for Payer: Humana Commercial |
$368.05
|
| Rate for Payer: Humana KY Medicaid |
$148.91
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$150.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.04
|
| Rate for Payer: Ohio Health Group HMO |
$324.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.77
|
| Rate for Payer: PHCS Commercial |
$415.68
|
| Rate for Payer: United Healthcare All Payer |
$381.04
|
|
|
X-RAY EXAM OFSHOULDER MIN 2V
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.90 |
| Max. Negotiated Rate |
$415.68 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.74
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$359.39
|
| Rate for Payer: First Health Commercial |
$411.35
|
| Rate for Payer: Humana Commercial |
$368.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.04
|
| Rate for Payer: Ohio Health Group HMO |
$324.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.77
|
| Rate for Payer: PHCS Commercial |
$415.68
|
| Rate for Payer: United Healthcare All Payer |
$381.04
|
|
|
X-RAY EXAM OFSHOULDER MIN 2V
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
32000075
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$259.80 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Ambetter Exchange |
$31.24
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.49
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$45.92
|
| Rate for Payer: Healthspan PPO |
$42.66
|
| Rate for Payer: Humana Medicaid |
$23.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.59
|
| Rate for Payer: Molina Healthcare Passport |
$23.13
|
| Rate for Payer: Multiplan PHCS |
$259.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.61
|
| Rate for Payer: UHCCP Medicaid |
$151.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.24
|
|
|
X-RAY EXAM OF SINUSES
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| 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 OF SINUSES
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
