|
X-RAY EXAM RIBS/CHEST4/> VWS
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
32000039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| 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: 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 |
$185.40
|
| 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
|
|
|
X-RAY EXAM RIBS/CHEST4/> VW(T
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
320T0039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
X-RAY EXAM RIBS/CHEST4/> VW(T
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
320T0039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$337.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.64
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$363.54
|
| Rate for Payer: First Health Commercial |
$416.10
|
| Rate for Payer: Humana Commercial |
$372.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$385.44
|
| Rate for Payer: Ohio Health Group HMO |
$328.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$381.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.22
|
| Rate for Payer: PHCS Commercial |
$420.48
|
| Rate for Payer: United Healthcare All Payer |
$385.44
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$337.26
|
| Rate for Payer: Anthem Medicaid |
$150.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$363.54
|
| Rate for Payer: First Health Commercial |
$416.10
|
| Rate for Payer: Humana Commercial |
$372.30
|
| Rate for Payer: Humana KY Medicaid |
$150.63
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$152.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$385.44
|
| Rate for Payer: Ohio Health Group HMO |
$328.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$381.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.22
|
| Rate for Payer: PHCS Commercial |
$420.48
|
| Rate for Payer: United Healthcare All Payer |
$385.44
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Aetna Commercial |
$49.98
|
| Rate for Payer: Ambetter Exchange |
$33.13
|
| Rate for Payer: Anthem Medicaid |
$25.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.76
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$49.38
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$25.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.58
|
| Rate for Payer: Molina Healthcare Passport |
$25.08
|
| Rate for Payer: Multiplan PHCS |
$262.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.07
|
| Rate for Payer: UHCCP Medicaid |
$153.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.13
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
320P0037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$49.98
|
| Rate for Payer: Ambetter Exchange |
$33.13
|
| Rate for Payer: Anthem Medicaid |
$25.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.76
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$49.38
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$25.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.58
|
| Rate for Payer: Molina Healthcare Passport |
$25.08
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.07
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.13
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS(T
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
320T0037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
X-RAY EXAM RIBS UNI 2 VIEWS(T
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
320T0037
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
X-RAY EXAM SACRUM TAILBONE
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
32000069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Ambetter Exchange |
$29.45
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.34
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$42.12
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.45
|
|
|
X-RAY EXAM SACRUM TAILBONE
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
32000069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
X-RAY EXAM SACRUM TAILBONE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
32000069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
X-RAY EXAM SACRUM TAILBONE(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
320P0069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$45.33 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Ambetter Exchange |
$29.45
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.34
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$42.12
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.45
|
|
|
X-RAY EXAM SACRUM TAILBONE(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
320T0069
|
|
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 SACRUM TAILBONE(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
320T0069
|
|
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 SI JOINTS 3/> VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
610P0027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$53.07 |
| Rate for Payer: Aetna Commercial |
$53.07
|
| Rate for Payer: Ambetter Exchange |
$35.51
|
| Rate for Payer: Anthem Medicaid |
$25.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.61
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$50.94
|
| Rate for Payer: Healthspan PPO |
$49.73
|
| Rate for Payer: Humana Medicaid |
$25.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.53
|
| Rate for Payer: Molina Healthcare Passport |
$25.03
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.16
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.51
|
|
|
X-RAY EXAM SI JOINTS 3/> VWS
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.70 |
| Max. Negotiated Rate |
$459.84 |
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$373.62
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna Commercial |
$397.57
|
| Rate for Payer: First Health Commercial |
$455.05
|
| Rate for Payer: Humana Commercial |
$407.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$421.52
|
| Rate for Payer: Ohio Health Group HMO |
$359.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.51
|
| Rate for Payer: PHCS Commercial |
$459.84
|
| Rate for Payer: United Healthcare All Payer |
$421.52
|
|
|
X-RAY EXAM SI JOINTS 3/> VWS
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$459.84 |
| Rate for Payer: Aetna Commercial |
$368.83
|
| Rate for Payer: Anthem Medicaid |
$164.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$373.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna Commercial |
$397.57
|
| Rate for Payer: First Health Commercial |
$455.05
|
| Rate for Payer: Humana Commercial |
$407.15
|
| Rate for Payer: Humana KY Medicaid |
$164.73
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$166.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$421.52
|
| Rate for Payer: Ohio Health Group HMO |
$359.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.51
|
| Rate for Payer: PHCS Commercial |
$459.84
|
| Rate for Payer: United Healthcare All Payer |
$421.52
|
|
|
X-RAY EXAM SI JOINTS 3/> VWS
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
61000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$287.40 |
| Rate for Payer: Aetna Commercial |
$53.07
|
| Rate for Payer: Ambetter Exchange |
$35.51
|
| Rate for Payer: Anthem Medicaid |
$25.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.61
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna Commercial |
$50.94
|
| Rate for Payer: Healthspan PPO |
$49.73
|
| Rate for Payer: Humana Medicaid |
$25.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.53
|
| Rate for Payer: Molina Healthcare Passport |
$25.03
|
| Rate for Payer: Multiplan PHCS |
$287.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.16
|
| Rate for Payer: UHCCP Medicaid |
$167.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.51
|
|
|
X-RAY EXAM SI JOINTS 3/> VW(T
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
610T0027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 SI JOINTS 3/> VW(T
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
610T0027
|
|
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
|
|
|
XRAY EXAM SKULL COMP, MIN 4V
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
XRAY EXAM SKULL COMP, MIN 4V
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$73.49
|
| Rate for Payer: Ambetter Exchange |
$40.37
|
| Rate for Payer: Anthem Medicaid |
$39.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.44
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$75.77
|
| Rate for Payer: Healthspan PPO |
$68.86
|
| Rate for Payer: Humana Medicaid |
$39.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.01
|
| Rate for Payer: Multiplan PHCS |
$338.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.48
|
| Rate for Payer: UHCCP Medicaid |
$197.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.37
|
|
|
XRAY EXAM SKULL COMP, MIN 4V
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$193.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$193.96
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$195.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
XRAY EXAM SKULL COMP, MIN 4V(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
320P0018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$75.77 |
| Rate for Payer: Aetna Commercial |
$73.49
|
| Rate for Payer: Ambetter Exchange |
$40.37
|
| Rate for Payer: Anthem Medicaid |
$39.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.44
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$75.77
|
| Rate for Payer: Healthspan PPO |
$68.86
|
| Rate for Payer: Humana Medicaid |
$39.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.01
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.48
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.37
|
|
