|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
610T0014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem Medicaid |
$1,179.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Humana KY Medicaid |
$1,179.23
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,531.84 |
| Rate for Payer: Ohio Health Choice Commercial |
$3,237.52
|
| Rate for Payer: Aetna Commercial |
$2,832.83
|
| Rate for Payer: Anthem Medicaid |
$1,265.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,869.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cigna Commercial |
$3,053.57
|
| Rate for Payer: First Health Commercial |
$3,495.05
|
| Rate for Payer: Humana Commercial |
$3,127.15
|
| Rate for Payer: Humana KY Medicaid |
$1,265.21
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,278.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,016.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,715.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,290.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.49
|
| Rate for Payer: PHCS Commercial |
$3,531.84
|
| Rate for Payer: United Healthcare All Payer |
$3,237.52
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$653.15
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,679.00
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cigna Commercial |
$770.90
|
| Rate for Payer: Healthspan PPO |
$448.81
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$2,207.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,575.30
|
| Rate for Payer: UHCCP Medicaid |
$1,287.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
|
|
MRI CERVICAL SPINE W/WO DYE
|
Professional
|
Both
|
$4,299.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$164.14 |
| Max. Negotiated Rate |
$4,299.00 |
| Rate for Payer: Aetna Commercial |
$1,023.39
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,299.00
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cigna Commercial |
$1,513.81
|
| Rate for Payer: Healthspan PPO |
$703.22
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$2,579.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,009.30
|
| Rate for Payer: UHCCP Medicaid |
$1,504.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
|
|
MRI CERVICAL SPINE W/WO DYE
|
Facility
|
IP
|
$4,299.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$558.87 |
| Max. Negotiated Rate |
$4,127.04 |
| Rate for Payer: Aetna Commercial |
$3,310.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,353.22
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cigna Commercial |
$3,568.17
|
| Rate for Payer: First Health Commercial |
$4,084.05
|
| Rate for Payer: Humana Commercial |
$3,654.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,525.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,783.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.69
|
| Rate for Payer: PHCS Commercial |
$4,127.04
|
| Rate for Payer: United Healthcare All Payer |
$3,783.12
|
|
|
MRI CERVICAL SPINE W/WO DYE
|
Facility
|
OP
|
$4,299.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,127.04 |
| Rate for Payer: Aetna Commercial |
$3,310.23
|
| Rate for Payer: Anthem Medicaid |
$1,478.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,353.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cigna Commercial |
$3,568.17
|
| Rate for Payer: First Health Commercial |
$4,084.05
|
| Rate for Payer: Humana Commercial |
$3,654.15
|
| Rate for Payer: Humana KY Medicaid |
$1,478.43
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,525.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,783.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.69
|
| Rate for Payer: PHCS Commercial |
$4,127.04
|
| Rate for Payer: United Healthcare All Payer |
$3,783.12
|
|
|
MRI CERVICAL SPINE W/WO DYE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
610P0020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$1,513.81 |
| Rate for Payer: Aetna Commercial |
$1,023.39
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$1,513.81
|
| Rate for Payer: Healthspan PPO |
$703.22
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
|
|
MRI CERVICAL SPINE W/WO DYE(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
610T0020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem Medicaid |
$1,375.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Humana KY Medicaid |
$1,375.26
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI CERVICAL SPINE W/WO DYE(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
610T0020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$519.87 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI CHEST W/CONTRAST
|
Professional
|
Both
|
$4,215.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
61000054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$4,215.00 |
| Rate for Payer: Aetna Commercial |
$779.50
|
| Rate for Payer: Anthem Medicaid |
$405.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,215.00
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cigna Commercial |
$940.01
|
| Rate for Payer: Healthspan PPO |
$535.63
|
| Rate for Payer: Humana Medicaid |
$405.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.73
|
| Rate for Payer: Molina Healthcare Passport |
$405.62
|
| Rate for Payer: Multiplan PHCS |
$2,529.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,950.50
|
| Rate for Payer: UHCCP Medicaid |
$1,475.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.68
|
|
|
MRI CHEST W/CONTRAST
|
Facility
|
OP
|
$4,215.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
61000054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$547.95 |
| Max. Negotiated Rate |
$4,046.40 |
| Rate for Payer: Aetna Commercial |
$3,245.55
|
| Rate for Payer: Anthem Medicaid |
$1,449.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,287.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cigna Commercial |
$3,498.45
|
| Rate for Payer: First Health Commercial |
$4,004.25
|
| Rate for Payer: Humana Commercial |
$3,582.75
|
| Rate for Payer: Humana KY Medicaid |
$1,449.54
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,464.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,456.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,110.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,478.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,709.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.65
|
| Rate for Payer: PHCS Commercial |
$4,046.40
|
| Rate for Payer: United Healthcare All Payer |
$3,709.20
|
|
|
MRI CHEST W/CONTRAST
|
Facility
|
IP
|
$4,215.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
61000054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$547.95 |
| Max. Negotiated Rate |
$4,046.40 |
| Rate for Payer: Aetna Commercial |
$3,245.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,287.70
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cigna Commercial |
$3,498.45
|
| Rate for Payer: First Health Commercial |
$4,004.25
|
| Rate for Payer: Humana Commercial |
$3,582.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,456.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,110.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,709.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.65
|
| Rate for Payer: PHCS Commercial |
$4,046.40
|
| Rate for Payer: United Healthcare All Payer |
$3,709.20
|
|
|
MRI CHEST W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
610P0054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$940.01 |
| Rate for Payer: Aetna Commercial |
$779.50
|
| Rate for Payer: Anthem Medicaid |
$405.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$940.01
|
| Rate for Payer: Healthspan PPO |
$535.63
|
| Rate for Payer: Humana Medicaid |
$405.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.73
|
| Rate for Payer: Molina Healthcare Passport |
$405.62
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.68
|
|
|
MRI CHEST W/CONTRAST(T
|
Facility
|
OP
|
$3,915.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
610T0054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$508.95 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem Medicaid |
$1,346.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.65
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
|
MRI CHEST W/CONTRAST(T
|
Facility
|
IP
|
$3,915.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
610T0054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$508.95 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.65
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
|
MRI CROME HF QUAD IS4 DF4
|
Facility
|
OP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem Medicaid |
$26,858.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Humana KY Medicaid |
$26,858.59
|
| Rate for Payer: Kentucky WC Medicaid |
$27,131.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,397.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
MRI CROME HF QUAD IS4 DF4
|
Facility
|
IP
|
$78,100.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,153.00 |
| Max. Negotiated Rate |
$74,976.00 |
| Rate for Payer: Aetna Commercial |
$60,137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,918.00
|
| Rate for Payer: Cash Price |
$39,050.00
|
| Rate for Payer: Cigna Commercial |
$64,823.00
|
| Rate for Payer: First Health Commercial |
$74,195.00
|
| Rate for Payer: Humana Commercial |
$66,385.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,042.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,637.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,430.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$58,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,153.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,211.00
|
| Rate for Payer: PHCS Commercial |
$74,976.00
|
| Rate for Payer: United Healthcare All Payer |
$68,728.00
|
|
|
MRI FACE WITH CONTRAST
|
Facility
|
OP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,717.12 |
| Rate for Payer: Aetna Commercial |
$2,981.44
|
| Rate for Payer: Anthem Medicaid |
$1,331.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,020.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$3,213.76
|
| Rate for Payer: First Health Commercial |
$3,678.40
|
| Rate for Payer: Humana Commercial |
$3,291.20
|
| Rate for Payer: Humana KY Medicaid |
$1,331.58
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,345.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,175.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,857.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,358.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,407.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,904.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.32
|
| Rate for Payer: PHCS Commercial |
$3,717.12
|
| Rate for Payer: United Healthcare All Payer |
$3,407.36
|
|
|
MRI FACE WITH CONTRAST
|
Facility
|
IP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$503.36 |
| Max. Negotiated Rate |
$3,717.12 |
| Rate for Payer: Aetna Commercial |
$2,981.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,020.16
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$3,213.76
|
| Rate for Payer: First Health Commercial |
$3,678.40
|
| Rate for Payer: Humana Commercial |
$3,291.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,175.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,857.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,407.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,904.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.32
|
| Rate for Payer: PHCS Commercial |
$3,717.12
|
| Rate for Payer: United Healthcare All Payer |
$3,407.36
|
|
|
MRI FACE WITH CONTRAST
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$3,872.00 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,872.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$893.77
|
| Rate for Payer: Healthspan PPO |
$529.79
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,323.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,710.40
|
| Rate for Payer: UHCCP Medicaid |
$1,355.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI FACE WITH CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
610P0003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$893.77 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$893.77
|
| Rate for Payer: Healthspan PPO |
$529.79
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI FACE WITH CONTRAST(T
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
610T0003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem Medicaid |
$1,228.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Humana KY Medicaid |
$1,228.41
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
MRI FACE WITH CONTRAST(T
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
610T0003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
MRI FACE WO CONTRAST
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,420.48 |
| Rate for Payer: Aetna Commercial |
$2,743.51
|
| Rate for Payer: Anthem Medicaid |
$1,225.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,779.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cigna Commercial |
$2,957.29
|
| Rate for Payer: First Health Commercial |
$3,384.85
|
| Rate for Payer: Humana Commercial |
$3,028.55
|
| Rate for Payer: Humana KY Medicaid |
$1,225.32
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,237.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,921.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,629.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,249.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,135.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,672.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.53
|
| Rate for Payer: PHCS Commercial |
$3,420.48
|
| Rate for Payer: United Healthcare All Payer |
$3,135.44
|
|
|
MRI FACE WO CONTRAST
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$463.19 |
| Max. Negotiated Rate |
$3,420.48 |
| Rate for Payer: Aetna Commercial |
$2,743.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,779.14
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cigna Commercial |
$2,957.29
|
| Rate for Payer: First Health Commercial |
$3,384.85
|
| Rate for Payer: Humana Commercial |
$3,028.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,921.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,629.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,135.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,672.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.53
|
| Rate for Payer: PHCS Commercial |
$3,420.48
|
| Rate for Payer: United Healthcare All Payer |
$3,135.44
|
|
