|
X-RAY EXAM OF SINUSES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
32000015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$242.40 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Ambetter Exchange |
$29.15
|
| Rate for Payer: Anthem Medicaid |
$24.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.98
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$47.54
|
| Rate for Payer: Healthspan PPO |
$42.62
|
| Rate for Payer: Humana Medicaid |
$24.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.65
|
| Rate for Payer: Molina Healthcare Passport |
$24.17
|
| Rate for Payer: Multiplan PHCS |
$242.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.90
|
| Rate for Payer: UHCCP Medicaid |
$141.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.15
|
|
|
X-RAY EXAM OF SINUSES
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.90 |
| Max. Negotiated Rate |
$482.88 |
| Rate for Payer: Aetna Commercial |
$387.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.34
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cigna Commercial |
$417.49
|
| Rate for Payer: First Health Commercial |
$477.85
|
| Rate for Payer: Humana Commercial |
$427.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$412.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$442.64
|
| Rate for Payer: Ohio Health Group HMO |
$377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.07
|
| Rate for Payer: PHCS Commercial |
$482.88
|
| Rate for Payer: United Healthcare All Payer |
$442.64
|
|
|
X-RAY EXAM OF SINUSES
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$301.80 |
| Rate for Payer: Aetna Commercial |
$59.37
|
| Rate for Payer: Ambetter Exchange |
$34.01
|
| Rate for Payer: Anthem Medicaid |
$32.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.81
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cigna Commercial |
$61.61
|
| Rate for Payer: Healthspan PPO |
$55.63
|
| Rate for Payer: Humana Medicaid |
$32.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.02
|
| Rate for Payer: Molina Healthcare Passport |
$32.37
|
| Rate for Payer: Multiplan PHCS |
$301.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.21
|
| Rate for Payer: UHCCP Medicaid |
$176.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.01
|
|
|
X-RAY EXAM OF SINUSES
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$482.88 |
| Rate for Payer: Aetna Commercial |
$387.31
|
| Rate for Payer: Anthem Medicaid |
$172.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cash Price |
$251.50
|
| Rate for Payer: Cigna Commercial |
$417.49
|
| Rate for Payer: First Health Commercial |
$477.85
|
| Rate for Payer: Humana Commercial |
$427.55
|
| Rate for Payer: Humana KY Medicaid |
$172.98
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$174.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$412.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$442.64
|
| Rate for Payer: Ohio Health Group HMO |
$377.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.07
|
| Rate for Payer: PHCS Commercial |
$482.88
|
| Rate for Payer: United Healthcare All Payer |
$442.64
|
|
|
X-RAY EXAM OF SINUSES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
320P0015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$47.54 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Ambetter Exchange |
$29.15
|
| Rate for Payer: Anthem Medicaid |
$24.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.98
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$47.54
|
| Rate for Payer: Healthspan PPO |
$42.62
|
| Rate for Payer: Humana Medicaid |
$24.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.65
|
| Rate for Payer: Molina Healthcare Passport |
$24.17
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.90
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.15
|
|
|
X-RAY EXAM OF SINUSES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
320P0016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$61.61 |
| Rate for Payer: Aetna Commercial |
$59.37
|
| Rate for Payer: Ambetter Exchange |
$34.01
|
| Rate for Payer: Anthem Medicaid |
$32.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.81
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$61.61
|
| Rate for Payer: Healthspan PPO |
$55.63
|
| Rate for Payer: Humana Medicaid |
$32.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.02
|
| Rate for Payer: Molina Healthcare Passport |
$32.37
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.21
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.01
|
|
|
X-RAY EXAM OF SINUSES(T
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
320T0016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem Medicaid |
$155.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Humana KY Medicaid |
$155.79
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$157.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
X-RAY EXAM OF SINUSES(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
320T0015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
X-RAY EXAM OF SINUSES(T
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
320T0016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.90 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.57
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
X-RAY EXAM OF SINUSES(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
320T0015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
X-RAY EXAM OF SPINE 1 VIEW
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
32000046
|
|
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 SPINE 1 VIEW
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
32000046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$195.60 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Ambetter Exchange |
$22.05
|
| Rate for Payer: Anthem Medicaid |
$17.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.46
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cigna Commercial |
$34.75
|
| Rate for Payer: Healthspan PPO |
$33.69
|
| Rate for Payer: Humana Medicaid |
$17.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.34
|
| Rate for Payer: Molina Healthcare Passport |
$17.98
|
| Rate for Payer: Multiplan PHCS |
$195.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.66
|
| Rate for Payer: UHCCP Medicaid |
$114.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.05
|
|
|
X-RAY EXAM OF SPINE 1 VIEW
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
32000046
|
|
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 SPINE 1 VIEW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
320P0046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Ambetter Exchange |
$22.05
|
| Rate for Payer: Anthem Medicaid |
$17.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.46
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$34.75
|
| Rate for Payer: Healthspan PPO |
$33.69
|
| Rate for Payer: Humana Medicaid |
$17.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.34
|
| Rate for Payer: Molina Healthcare Passport |
$17.98
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.66
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.05
|
|
|
X-RAY EXAM OF SPINE 1 VIEW(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
320T0046
|
|
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 SPINE 1 VIEW(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
320T0046
|
|
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 TOE(S)
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
32000112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
X-RAY EXAM OF TOE(S)
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
32000112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$286.80 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Ambetter Exchange |
$26.09
|
| Rate for Payer: Anthem Medicaid |
$17.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Healthspan PPO |
$38.12
|
| Rate for Payer: Humana Medicaid |
$17.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare Passport |
$17.12
|
| Rate for Payer: Multiplan PHCS |
$286.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.92
|
| Rate for Payer: UHCCP Medicaid |
$167.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.09
|
|
|
X-RAY EXAM OF TOE(S)
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
32000112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
X-RAY EXAM OF TOE(S)(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
320P0112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$40.68 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Ambetter Exchange |
$26.09
|
| Rate for Payer: Anthem Medicaid |
$17.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Healthspan PPO |
$38.12
|
| Rate for Payer: Humana Medicaid |
$17.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare Passport |
$17.12
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.92
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.09
|
|
|
X-RAY EXAM OF TOE(S)(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
320T0112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
X-RAY EXAM OF TOE(S)(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
320T0112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
X-RAY EXAM RIBS/CHEST4/> VW(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
320P0039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Aetna Commercial |
$79.11
|
| Rate for Payer: Ambetter Exchange |
$47.30
|
| Rate for Payer: Anthem Medicaid |
$38.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.76
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$76.23
|
| Rate for Payer: Healthspan PPO |
$74.13
|
| Rate for Payer: Humana Medicaid |
$38.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.92
|
| Rate for Payer: Molina Healthcare Passport |
$38.16
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.49
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.30
|
|
|
X-RAY EXAM RIBS/CHEST4/> VWS
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
32000039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Aetna Commercial |
$79.11
|
| Rate for Payer: Ambetter Exchange |
$47.30
|
| Rate for Payer: Anthem Medicaid |
$38.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.76
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$76.23
|
| Rate for Payer: Healthspan PPO |
$74.13
|
| Rate for Payer: Humana Medicaid |
$38.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.92
|
| Rate for Payer: Molina Healthcare Passport |
$38.16
|
| Rate for Payer: Multiplan PHCS |
$370.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.49
|
| Rate for Payer: UHCCP Medicaid |
$216.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.30
|
|
|
X-RAY EXAM RIBS/CHEST4/> VWS
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
32000039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem Medicaid |
$212.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Humana KY Medicaid |
$212.53
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$214.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
