|
X-RAY EXAM UNILAT RIBS/CHEST
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
32000038
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$456.96 |
| Rate for Payer: Aetna Commercial |
$366.52
|
| Rate for Payer: Anthem Medicaid |
$163.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$371.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$238.00
|
| 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: Humana KY Medicaid |
$163.70
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$165.36
|
| 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 |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.98
|
| 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
|
|
|
X-RAY FOR PANCREAS ENDOSCOP(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
320P0282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$158.13 |
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY FOR PANCREAS ENDOSCOP(T
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
320T0282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.30 |
| Max. Negotiated Rate |
$1,114.56 |
| Rate for Payer: Aetna Commercial |
$893.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$905.58
|
| Rate for Payer: Cash Price |
$580.50
|
| Rate for Payer: Cigna Commercial |
$963.63
|
| Rate for Payer: First Health Commercial |
$1,102.95
|
| Rate for Payer: Humana Commercial |
$986.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,021.68
|
| Rate for Payer: Ohio Health Group HMO |
$870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$928.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.09
|
| Rate for Payer: PHCS Commercial |
$1,114.56
|
| Rate for Payer: United Healthcare All Payer |
$1,021.68
|
|
|
X-RAY FOR PANCREAS ENDOSCOP(T
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
320T0282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.30 |
| Max. Negotiated Rate |
$1,114.56 |
| Rate for Payer: Aetna Commercial |
$893.97
|
| Rate for Payer: Anthem Medicaid |
$399.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$905.58
|
| Rate for Payer: Cash Price |
$580.50
|
| Rate for Payer: Cigna Commercial |
$963.63
|
| Rate for Payer: First Health Commercial |
$1,102.95
|
| Rate for Payer: Humana Commercial |
$986.85
|
| Rate for Payer: Humana KY Medicaid |
$399.27
|
| Rate for Payer: Kentucky WC Medicaid |
$403.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$856.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$407.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,021.68
|
| Rate for Payer: Ohio Health Group HMO |
$870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$928.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.09
|
| Rate for Payer: PHCS Commercial |
$1,114.56
|
| Rate for Payer: United Healthcare All Payer |
$1,021.68
|
|
|
X-RAY FOR PANCREAS ENDOSCOPY
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$952.70 |
| Rate for Payer: Aetna Commercial |
$158.13
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$816.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$952.70
|
| Rate for Payer: UHCCP Medicaid |
$476.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY FOR PANCREAS ENDOSCOPY
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.30 |
| Max. Negotiated Rate |
$1,306.56 |
| Rate for Payer: Aetna Commercial |
$1,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,061.58
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$1,129.63
|
| Rate for Payer: First Health Commercial |
$1,292.95
|
| Rate for Payer: Humana Commercial |
$1,156.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,116.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,004.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,197.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,184.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$939.09
|
| Rate for Payer: PHCS Commercial |
$1,306.56
|
| Rate for Payer: United Healthcare All Payer |
$1,197.68
|
|
|
X-RAY FOR PANCREAS ENDOSCOPY
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
HCPCS 74329
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.30 |
| Max. Negotiated Rate |
$1,306.56 |
| Rate for Payer: Aetna Commercial |
$1,047.97
|
| Rate for Payer: Anthem Medicaid |
$468.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,061.58
|
| Rate for Payer: Cash Price |
$680.50
|
| Rate for Payer: Cigna Commercial |
$1,129.63
|
| Rate for Payer: First Health Commercial |
$1,292.95
|
| Rate for Payer: Humana Commercial |
$1,156.85
|
| Rate for Payer: Humana KY Medicaid |
$468.05
|
| Rate for Payer: Kentucky WC Medicaid |
$472.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,116.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,004.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,197.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,020.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,184.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$939.09
|
| Rate for Payer: PHCS Commercial |
$1,306.56
|
| Rate for Payer: United Healthcare All Payer |
$1,197.68
|
|
|
X-RAY OF LOWER SPINE DISK
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,460.89 |
| Max. Negotiated Rate |
$4,078.08 |
| Rate for Payer: Aetna Commercial |
$3,270.96
|
| Rate for Payer: Anthem Medicaid |
$1,460.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$3,525.84
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Humana Commercial |
$3,610.80
|
| Rate for Payer: Humana KY Medicaid |
$1,460.89
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,398.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,695.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,931.12
|
| Rate for Payer: PHCS Commercial |
$4,078.08
|
| Rate for Payer: United Healthcare All Payer |
$3,738.24
|
|
|
X-RAY OF LOWER SPINE DISK
|
Professional
|
Both
|
$4,248.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$2,548.80 |
| Rate for Payer: Aetna Commercial |
$248.16
|
| Rate for Payer: Ambetter Exchange |
$100.42
|
| Rate for Payer: Anthem Medicaid |
$248.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.50
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$425.48
|
| Rate for Payer: Healthspan PPO |
$232.53
|
| Rate for Payer: Humana Medicaid |
$248.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.04
|
| Rate for Payer: Molina Healthcare Passport |
$248.08
|
| Rate for Payer: Multiplan PHCS |
$2,548.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.55
|
| Rate for Payer: UHCCP Medicaid |
$1,486.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.42
|
|
|
X-RAY OF LOWER SPINE DISK
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
32000071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,274.40 |
| Max. Negotiated Rate |
$4,078.08 |
| Rate for Payer: Aetna Commercial |
$3,270.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.44
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cigna Commercial |
$3,525.84
|
| Rate for Payer: First Health Commercial |
$4,035.60
|
| Rate for Payer: Humana Commercial |
$3,610.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,398.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,695.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,931.12
|
| Rate for Payer: PHCS Commercial |
$4,078.08
|
| Rate for Payer: United Healthcare All Payer |
$3,738.24
|
|
|
X-RAY OF LOWER SPINE DISK(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
320P0071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$425.48 |
| Rate for Payer: Aetna Commercial |
$248.16
|
| Rate for Payer: Ambetter Exchange |
$100.42
|
| Rate for Payer: Anthem Medicaid |
$248.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$425.48
|
| Rate for Payer: Healthspan PPO |
$232.53
|
| Rate for Payer: Humana Medicaid |
$248.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.04
|
| Rate for Payer: Molina Healthcare Passport |
$248.08
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.55
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.42
|
|
|
X-RAY OF LOWER SPINE DISK(T
|
Facility
|
IP
|
$3,973.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
320T0071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,191.90 |
| Max. Negotiated Rate |
$3,814.08 |
| Rate for Payer: Aetna Commercial |
$3,059.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.94
|
| Rate for Payer: Cash Price |
$1,986.50
|
| Rate for Payer: Cigna Commercial |
$3,297.59
|
| Rate for Payer: First Health Commercial |
$3,774.35
|
| Rate for Payer: Humana Commercial |
$3,377.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,932.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,496.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,456.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,741.37
|
| Rate for Payer: PHCS Commercial |
$3,814.08
|
| Rate for Payer: United Healthcare All Payer |
$3,496.24
|
|
|
X-RAY OF LOWER SPINE DISK(T
|
Facility
|
OP
|
$3,973.00
|
|
|
Service Code
|
HCPCS 72295
|
| Hospital Charge Code |
320T0071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,366.31 |
| Max. Negotiated Rate |
$3,814.08 |
| Rate for Payer: Aetna Commercial |
$3,059.21
|
| Rate for Payer: Anthem Medicaid |
$1,366.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$1,986.50
|
| Rate for Payer: Cash Price |
$1,986.50
|
| Rate for Payer: Cigna Commercial |
$3,297.59
|
| Rate for Payer: First Health Commercial |
$3,774.35
|
| Rate for Payer: Humana Commercial |
$3,377.05
|
| Rate for Payer: Humana KY Medicaid |
$1,366.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,380.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,932.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,496.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,456.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,741.37
|
| Rate for Payer: PHCS Commercial |
$3,814.08
|
| Rate for Payer: United Healthcare All Payer |
$3,496.24
|
|
|
X-RAYS BONE LENGTH STUDIES
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
32000235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Ambetter Exchange |
$40.94
|
| Rate for Payer: Anthem Medicaid |
$29.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.13
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Healthspan PPO |
$54.21
|
| Rate for Payer: Humana Medicaid |
$29.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.45
|
| Rate for Payer: Molina Healthcare Passport |
$29.85
|
| Rate for Payer: Multiplan PHCS |
$212.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.22
|
| Rate for Payer: UHCCP Medicaid |
$123.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.94
|
|
|
X-RAYS BONE LENGTH STUDIES
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
32000235
|
|
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-RAYS BONE LENGTH STUDIES
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
32000235
|
|
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-RAYS BONE LENGTH STUDIES(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
320P0235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Aetna Commercial |
$57.85
|
| Rate for Payer: Ambetter Exchange |
$40.94
|
| Rate for Payer: Anthem Medicaid |
$29.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.13
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Healthspan PPO |
$54.21
|
| Rate for Payer: Humana Medicaid |
$29.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.45
|
| Rate for Payer: Molina Healthcare Passport |
$29.85
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.22
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.94
|
|
|
X-RAYS BONE LENGTH STUDIES(T
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
320T0235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
X-RAYS BONE LENGTH STUDIES(T
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
320T0235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
X-RAYS BONE SURVEY LIMITED
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem Medicaid |
$256.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Humana KY Medicaid |
$256.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$259.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
X-RAYS BONE SURVEY LIMITED
|
Professional
|
Both
|
$746.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Ambetter Exchange |
$59.14
|
| Rate for Payer: Anthem Medicaid |
$45.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.97
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$94.33
|
| Rate for Payer: Healthspan PPO |
$98.39
|
| Rate for Payer: Humana Medicaid |
$45.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.34
|
| Rate for Payer: Molina Healthcare Passport |
$45.43
|
| Rate for Payer: Multiplan PHCS |
$447.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.88
|
| Rate for Payer: UHCCP Medicaid |
$261.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.14
|
|
|
X-RAYS BONE SURVEY LIMITED
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
X-RAYS BONE SURVEY LIMITED(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
320P0294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Ambetter Exchange |
$59.14
|
| Rate for Payer: Anthem Medicaid |
$45.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.97
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$94.33
|
| Rate for Payer: Healthspan PPO |
$98.39
|
| Rate for Payer: Humana Medicaid |
$45.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.34
|
| Rate for Payer: Molina Healthcare Passport |
$45.43
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.88
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.14
|
|
|
X-RAYS BONE SURVEY LIMITED(T
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
320T0294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.88
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$411.24
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
|
X-RAYS BONE SURVEY LIMITED(T
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 77074
|
| Hospital Charge Code |
320T0294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem Medicaid |
$204.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Humana KY Medicaid |
$204.96
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$207.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$209.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$411.24
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
