|
XRAY EXAM SKULL COMP, MIN 4V(T
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
320T0018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem Medicaid |
$168.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Humana KY Medicaid |
$168.17
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$169.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.41
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
|
XRAY EXAM SKULL COMP, MIN 4V(T
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
320T0018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$469.44 |
| Rate for Payer: Aetna Commercial |
$376.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.42
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$405.87
|
| Rate for Payer: First Health Commercial |
$464.55
|
| Rate for Payer: Humana Commercial |
$415.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.32
|
| Rate for Payer: Ohio Health Group HMO |
$366.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.41
|
| Rate for Payer: PHCS Commercial |
$469.44
|
| Rate for Payer: United Healthcare All Payer |
$430.32
|
|
|
X-RAY EXAM THORACOLMB 2/> V(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
320P0269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$53.72
|
| Rate for Payer: Ambetter Exchange |
$31.33
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$54.35
|
| Rate for Payer: Healthspan PPO |
$50.34
|
| Rate for Payer: Humana Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.07
|
| Rate for Payer: Molina Healthcare Passport |
$27.52
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.73
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.33
|
|
|
X-RAY EXAM THORACOLMB 2/> V(T
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
320T0269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
X-RAY EXAM THORACOLMB 2/> V(T
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
320T0269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
32000269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$53.72
|
| Rate for Payer: Ambetter Exchange |
$31.33
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$54.35
|
| Rate for Payer: Healthspan PPO |
$50.34
|
| Rate for Payer: Humana Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.07
|
| Rate for Payer: Molina Healthcare Passport |
$27.52
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.73
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.33
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
32000269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
32000269
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
X-RAY EXAM THORAC SPINE 2VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
320P0050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Aetna Commercial |
$51.58
|
| Rate for Payer: Ambetter Exchange |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.80
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: Healthspan PPO |
$48.33
|
| Rate for Payer: Humana Medicaid |
$26.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.52
|
| Rate for Payer: Molina Healthcare Passport |
$26.98
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.78
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.83
|
|
|
X-RAY EXAM THORAC SPINE 2VWS
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$242.40 |
| Rate for Payer: Aetna Commercial |
$51.58
|
| Rate for Payer: Ambetter Exchange |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.80
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$52.70
|
| Rate for Payer: Healthspan PPO |
$48.33
|
| Rate for Payer: Humana Medicaid |
$26.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.52
|
| Rate for Payer: Molina Healthcare Passport |
$26.98
|
| Rate for Payer: Multiplan PHCS |
$242.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.78
|
| Rate for Payer: UHCCP Medicaid |
$141.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.83
|
|
|
X-RAY EXAM THORAC SPINE 2VWS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
32000050
|
|
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 THORAC SPINE 2VWS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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
|
|
|
X-RAY EXAM THORAC SPINE 2VW(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
320T0050
|
|
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 THORAC SPINE 2VW(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
320T0050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 THORAC SPINE 3VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
320P0268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: Aetna Commercial |
$58.72
|
| Rate for Payer: Ambetter Exchange |
$35.51
|
| Rate for Payer: Anthem Medicaid |
$29.37
|
| 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 |
$58.23
|
| Rate for Payer: Healthspan PPO |
$55.02
|
| Rate for Payer: Humana Medicaid |
$29.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| 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 |
$29.96
|
| Rate for Payer: Molina Healthcare Passport |
$29.37
|
| 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 |
$29.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.51
|
|
|
X-RAY EXAM THORAC SPINE 3VWS
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
32000268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Aetna Commercial |
$58.72
|
| Rate for Payer: Ambetter Exchange |
$35.51
|
| Rate for Payer: Anthem Medicaid |
$29.37
|
| 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 |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$58.23
|
| Rate for Payer: Healthspan PPO |
$55.02
|
| Rate for Payer: Humana Medicaid |
$29.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| 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 |
$29.96
|
| Rate for Payer: Molina Healthcare Passport |
$29.37
|
| Rate for Payer: Multiplan PHCS |
$318.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.16
|
| Rate for Payer: UHCCP Medicaid |
$185.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.51
|
|
|
X-RAY EXAM THORAC SPINE 3VWS
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
32000268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
X-RAY EXAM THORAC SPINE 3VWS
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
32000268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
X-RAY EXAM THORAC SPINE 3VW(T
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
320T0268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.18
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.89
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
X-RAY EXAM THORAC SPINE 3VW(T
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
320T0268
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem Medicaid |
$165.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Humana KY Medicaid |
$165.42
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$167.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.89
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
X-RAY EXAM UNILAT RIBS/CHES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
320P0038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$59.82 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Ambetter Exchange |
$37.99
|
| Rate for Payer: Anthem Medicaid |
$30.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.59
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Healthspan PPO |
$56.05
|
| Rate for Payer: Humana Medicaid |
$30.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.63
|
| Rate for Payer: Molina Healthcare Passport |
$30.03
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.39
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.99
|
|
|
X-RAY EXAM UNILAT RIBS/CHES(T
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
320T0038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$408.96 |
| Rate for Payer: Aetna Commercial |
$328.02
|
| Rate for Payer: Anthem Medicaid |
$146.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$353.58
|
| Rate for Payer: First Health Commercial |
$404.70
|
| Rate for Payer: Humana Commercial |
$362.10
|
| Rate for Payer: Humana KY Medicaid |
$146.50
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$147.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$349.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$314.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.88
|
| Rate for Payer: Ohio Health Group HMO |
$319.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.94
|
| Rate for Payer: PHCS Commercial |
$408.96
|
| Rate for Payer: United Healthcare All Payer |
$374.88
|
|
|
X-RAY EXAM UNILAT RIBS/CHES(T
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
320T0038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$408.96 |
| Rate for Payer: Aetna Commercial |
$328.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.28
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$353.58
|
| Rate for Payer: First Health Commercial |
$404.70
|
| Rate for Payer: Humana Commercial |
$362.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$349.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$314.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.88
|
| Rate for Payer: Ohio Health Group HMO |
$319.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.94
|
| Rate for Payer: PHCS Commercial |
$408.96
|
| Rate for Payer: United Healthcare All Payer |
$374.88
|
|
|
X-RAY EXAM UNILAT RIBS/CHEST
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
32000038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Ambetter Exchange |
$37.99
|
| Rate for Payer: Anthem Medicaid |
$30.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.59
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Healthspan PPO |
$56.05
|
| Rate for Payer: Humana Medicaid |
$30.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.63
|
| Rate for Payer: Molina Healthcare Passport |
$30.03
|
| Rate for Payer: Multiplan PHCS |
$285.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.39
|
| Rate for Payer: UHCCP Medicaid |
$166.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.99
|
|
|
X-RAY EXAM UNILAT RIBS/CHEST
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
32000038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$456.96 |
| Rate for Payer: Aetna Commercial |
$366.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$371.28
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$395.08
|
| Rate for Payer: First Health Commercial |
$452.20
|
| Rate for Payer: Humana Commercial |
$404.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$390.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$351.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.88
|
| Rate for Payer: Ohio Health Group HMO |
$357.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.44
|
| Rate for Payer: PHCS Commercial |
$456.96
|
| Rate for Payer: United Healthcare All Payer |
$418.88
|
|
