|
X-RAY STRENOCLAVIC JT 3/>VW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
320P0041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Ambetter Exchange |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$28.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.35
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$57.11
|
| Rate for Payer: Healthspan PPO |
$53.35
|
| Rate for Payer: Humana Medicaid |
$28.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.89
|
| Rate for Payer: Molina Healthcare Passport |
$28.32
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.05
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.96
|
|
|
X-RAY STRENOCLAVIC JT 3/>VWS
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem Medicaid |
$163.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Humana KY Medicaid |
$163.01
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$164.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.06
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
X-RAY STRENOCLAVIC JT 3/>VWS
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Aetna Commercial |
$56.94
|
| Rate for Payer: Ambetter Exchange |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$28.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.35
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$57.11
|
| Rate for Payer: Healthspan PPO |
$53.35
|
| Rate for Payer: Humana Medicaid |
$28.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.89
|
| Rate for Payer: Molina Healthcare Passport |
$28.32
|
| Rate for Payer: Multiplan PHCS |
$284.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.05
|
| Rate for Payer: UHCCP Medicaid |
$165.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.96
|
|
|
X-RAY STRENOCLAVIC JT 3/>VWS
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
32000041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.06
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
X-RAY STRENOCLAVIC JT 3/>VW(T
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
320T0041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$407.04 |
| Rate for Payer: Aetna Commercial |
$326.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.72
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$351.92
|
| Rate for Payer: First Health Commercial |
$402.80
|
| Rate for Payer: Humana Commercial |
$360.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$347.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$312.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$373.12
|
| Rate for Payer: Ohio Health Group HMO |
$318.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$339.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.56
|
| Rate for Payer: PHCS Commercial |
$407.04
|
| Rate for Payer: United Healthcare All Payer |
$373.12
|
|
|
X-RAY STRENOCLAVIC JT 3/>VW(T
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
320T0041
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$407.04 |
| Rate for Payer: Aetna Commercial |
$326.48
|
| Rate for Payer: Anthem Medicaid |
$145.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$351.92
|
| Rate for Payer: First Health Commercial |
$402.80
|
| Rate for Payer: Humana Commercial |
$360.40
|
| Rate for Payer: Humana KY Medicaid |
$145.81
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$147.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$347.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$312.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$148.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$373.12
|
| Rate for Payer: Ohio Health Group HMO |
$318.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$339.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.56
|
| Rate for Payer: PHCS Commercial |
$407.04
|
| Rate for Payer: United Healthcare All Payer |
$373.12
|
|
|
X-RAY STRESS VIEW
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Ambetter Exchange |
$49.45
|
| Rate for Payer: Anthem Medicaid |
$21.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.34
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$43.45
|
| Rate for Payer: Healthspan PPO |
$57.27
|
| Rate for Payer: Humana Medicaid |
$21.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.13
|
| Rate for Payer: Molina Healthcare Passport |
$21.70
|
| Rate for Payer: Multiplan PHCS |
$262.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.28
|
| Rate for Payer: UHCCP Medicaid |
$152.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.45
|
|
|
X-RAY STRESS VIEW
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
X-RAY STRESS VIEW
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
32000293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$336.49
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$362.71
|
| Rate for Payer: First Health Commercial |
$415.15
|
| Rate for Payer: Humana Commercial |
$371.45
|
| Rate for Payer: Humana KY Medicaid |
$150.28
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.56
|
| Rate for Payer: Ohio Health Group HMO |
$327.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.53
|
| Rate for Payer: PHCS Commercial |
$419.52
|
| Rate for Payer: United Healthcare All Payer |
$384.56
|
|
|
X-RAY STRESS VIEW(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
320P0293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Ambetter Exchange |
$49.45
|
| Rate for Payer: Anthem Medicaid |
$21.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.34
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$43.45
|
| Rate for Payer: Healthspan PPO |
$57.27
|
| Rate for Payer: Humana Medicaid |
$21.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.13
|
| Rate for Payer: Molina Healthcare Passport |
$21.70
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.28
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.45
|
|
|
X-RAY STRESS VIEW(T
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
320T0293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
X-RAY STRESS VIEW(T
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
320T0293
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
X-RAY UPPER GI DELAY W/O KUB
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
X-RAY UPPER GI DELAY W/O KUB
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$162.74
|
| Rate for Payer: Ambetter Exchange |
$109.17
|
| Rate for Payer: Anthem Medicaid |
$90.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$142.09
|
| Rate for Payer: Healthspan PPO |
$152.49
|
| Rate for Payer: Humana Medicaid |
$90.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.28
|
| Rate for Payer: Molina Healthcare Passport |
$90.47
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.92
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.17
|
|
|
X-RAY UPPER GI DELAY W/O KUB
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
32000131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem Medicaid |
$302.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Humana KY Medicaid |
$302.63
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$305.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
X-RAY UPPER GI DELAY W/O KU(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
320P0131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$162.74 |
| Rate for Payer: Aetna Commercial |
$162.74
|
| Rate for Payer: Ambetter Exchange |
$109.17
|
| Rate for Payer: Anthem Medicaid |
$90.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$142.09
|
| Rate for Payer: Healthspan PPO |
$152.49
|
| Rate for Payer: Humana Medicaid |
$90.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.28
|
| Rate for Payer: Molina Healthcare Passport |
$90.47
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.92
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.17
|
|
|
X-RAY UPPER GI DELAY W/O KU(T
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
320T0131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem Medicaid |
$242.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Humana KY Medicaid |
$242.45
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$244.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
X-RAY UPPER GI DELAY W/O KU(T
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
320T0131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
X-RAY URETHRA/BLADDER
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
32001022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.60 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.58
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
X-RAY URETHRA/BLADDER
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
32001022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$687.40 |
| Rate for Payer: Aetna Commercial |
$115.02
|
| Rate for Payer: Anthem Medicaid |
$53.66
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$109.96
|
| Rate for Payer: Healthspan PPO |
$236.13
|
| Rate for Payer: Humana Medicaid |
$53.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.73
|
| Rate for Payer: Molina Healthcare Passport |
$53.66
|
| Rate for Payer: Multiplan PHCS |
$589.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$687.40
|
| Rate for Payer: UHCCP Medicaid |
$343.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.20
|
|
|
X-RAY URETHRA/BLADDER
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
32001022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem Medicaid |
$337.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Humana KY Medicaid |
$337.71
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$341.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.58
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
X-RAY URETHRA/BLADDER (P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
320P1022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$236.13 |
| Rate for Payer: Aetna Commercial |
$115.02
|
| Rate for Payer: Anthem Medicaid |
$53.66
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$109.96
|
| Rate for Payer: Healthspan PPO |
$236.13
|
| Rate for Payer: Humana Medicaid |
$53.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.73
|
| Rate for Payer: Molina Healthcare Passport |
$53.66
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.20
|
|
|
X-RAY URETHRA/BLADDER (T
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
320T1022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$323.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Humana KY Medicaid |
$323.95
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.98
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
X-RAY URETHRA/BLADDER (T
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
320T1022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.98
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
X-RAY XM ESOPHAGUS 1CNTRST
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32001024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem Medicaid |
$187.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Humana KY Medicaid |
$187.08
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$188.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$375.36
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
