|
MRI FACE WO CONTRAST
|
Professional
|
Both
|
$3,563.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$3,563.00 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,563.00
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cigna Commercial |
$764.72
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,137.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,494.10
|
| Rate for Payer: UHCCP Medicaid |
$1,247.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI FACE WO CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
610P0002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$764.72 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$764.72
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI FACE WO CONTRAST(T
|
Facility
|
OP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
610T0002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,180.48 |
| Rate for Payer: Aetna Commercial |
$2,551.01
|
| Rate for Payer: Anthem Medicaid |
$1,139.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,656.50
|
| Rate for Payer: Cash Price |
$1,656.50
|
| Rate for Payer: Cigna Commercial |
$2,749.79
|
| Rate for Payer: First Health Commercial |
$3,147.35
|
| Rate for Payer: Humana Commercial |
$2,816.05
|
| Rate for Payer: Humana KY Medicaid |
$1,139.34
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.03
|
| Rate for Payer: PHCS Commercial |
$3,180.48
|
| Rate for Payer: United Healthcare All Payer |
$2,915.44
|
|
|
MRI FACE WO CONTRAST(T
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
610T0002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$3,180.48 |
| Rate for Payer: Aetna Commercial |
$2,551.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.14
|
| Rate for Payer: Cash Price |
$1,656.50
|
| Rate for Payer: Cigna Commercial |
$2,749.79
|
| Rate for Payer: First Health Commercial |
$3,147.35
|
| Rate for Payer: Humana Commercial |
$2,816.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.03
|
| Rate for Payer: PHCS Commercial |
$3,180.48
|
| Rate for Payer: United Healthcare All Payer |
$2,915.44
|
|
|
MRI FACE W WO CONTRAST
|
Professional
|
Both
|
$4,224.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$4,224.00 |
| Rate for Payer: Aetna Commercial |
$983.53
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,224.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cigna Commercial |
$1,471.34
|
| Rate for Payer: Healthspan PPO |
$675.83
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$2,534.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,956.80
|
| Rate for Payer: UHCCP Medicaid |
$1,478.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
|
|
MRI FACE W WO CONTRAST
|
Facility
|
OP
|
$4,224.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,055.04 |
| Rate for Payer: Aetna Commercial |
$3,252.48
|
| Rate for Payer: Anthem Medicaid |
$1,452.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,294.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cigna Commercial |
$3,505.92
|
| Rate for Payer: First Health Commercial |
$4,012.80
|
| Rate for Payer: Humana Commercial |
$3,590.40
|
| Rate for Payer: Humana KY Medicaid |
$1,452.63
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,467.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,463.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,117.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,717.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.44
|
| Rate for Payer: PHCS Commercial |
$4,055.04
|
| Rate for Payer: United Healthcare All Payer |
$3,717.12
|
|
|
MRI FACE W WO CONTRAST
|
Facility
|
IP
|
$4,224.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$549.12 |
| Max. Negotiated Rate |
$4,055.04 |
| Rate for Payer: Aetna Commercial |
$3,252.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,294.72
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cigna Commercial |
$3,505.92
|
| Rate for Payer: First Health Commercial |
$4,012.80
|
| Rate for Payer: Humana Commercial |
$3,590.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,463.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,117.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,267.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,717.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.44
|
| Rate for Payer: PHCS Commercial |
$4,055.04
|
| Rate for Payer: United Healthcare All Payer |
$3,717.12
|
|
|
MRI FACE W WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
610P0004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,471.34 |
| Rate for Payer: Aetna Commercial |
$983.53
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,471.34
|
| Rate for Payer: Healthspan PPO |
$675.83
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
|
|
MRI FACE W WO CONTRAST(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
610T0004
|
|
Hospital Revenue Code
|
610
|
| 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 FACE W WO CONTRAST(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
610T0004
|
|
Hospital Revenue Code
|
610
|
| 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 ICD COBALT DDPA2D4
|
Facility
|
OP
|
$38,813.88
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,045.80 |
| Max. Negotiated Rate |
$37,261.32 |
| Rate for Payer: Humana Commercial |
$32,991.80
|
| Rate for Payer: Aetna Commercial |
$29,886.69
|
| Rate for Payer: Anthem Medicaid |
$13,348.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,274.83
|
| Rate for Payer: Cash Price |
$19,406.94
|
| Rate for Payer: Cigna Commercial |
$32,215.52
|
| Rate for Payer: First Health Commercial |
$36,873.19
|
| Rate for Payer: Humana KY Medicaid |
$13,348.09
|
| Rate for Payer: Kentucky WC Medicaid |
$13,483.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,827.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,644.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,644.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,615.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,156.21
|
| Rate for Payer: Ohio Health Group HMO |
$29,110.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,762.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,045.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,032.30
|
| Rate for Payer: PHCS Commercial |
$37,261.32
|
| Rate for Payer: United Healthcare All Payer |
$34,156.21
|
|
|
MRI ICD COBALT DDPA2D4
|
Facility
|
IP
|
$38,813.88
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,045.80 |
| Max. Negotiated Rate |
$37,261.32 |
| Rate for Payer: Aetna Commercial |
$29,886.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,274.83
|
| Rate for Payer: Cash Price |
$19,406.94
|
| Rate for Payer: Cigna Commercial |
$32,215.52
|
| Rate for Payer: First Health Commercial |
$36,873.19
|
| Rate for Payer: Humana Commercial |
$32,991.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,827.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,644.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,644.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,156.21
|
| Rate for Payer: Ohio Health Group HMO |
$29,110.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,762.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,045.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,032.30
|
| Rate for Payer: PHCS Commercial |
$37,261.32
|
| Rate for Payer: United Healthcare All Payer |
$34,156.21
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
61000037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Anthem Medicaid |
$344.77
|
| 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 |
$761.42
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$344.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.67
|
| Rate for Payer: Molina Healthcare Passport |
$344.77
|
| 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 |
$348.22
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
61000037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$478.27 |
| Max. Negotiated Rate |
$3,531.84 |
| Rate for Payer: Aetna Commercial |
$2,832.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,869.62
|
| 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: 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 |
$1,103.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,237.52
|
| 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 JNT OF LWR EXTRE W/O DYE
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
61000037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,531.84 |
| 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 Choice Commercial |
$3,237.52
|
| 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 JNT OF LWR EXTRE W/O DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
610P0037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$761.42 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Anthem Medicaid |
$344.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$761.42
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$344.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.67
|
| Rate for Payer: Molina Healthcare Passport |
$344.77
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.22
|
|
|
MRI JNT OF LWR EXTRE W/O DY(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
610T0037
|
|
Hospital Revenue Code
|
610
|
| 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 JNT OF LWR EXTRE W/O DY(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
610T0037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$445.77 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| 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: 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 |
$1,028.70
|
| 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 JOINT LWR EXTR W/O&W/DYE
|
Professional
|
Both
|
$4,224.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$4,224.00 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,224.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cigna Commercial |
$1,455.90
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$2,534.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,956.80
|
| Rate for Payer: UHCCP Medicaid |
$1,478.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,224.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$549.12 |
| Max. Negotiated Rate |
$4,055.04 |
| Rate for Payer: Aetna Commercial |
$3,252.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,294.72
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cigna Commercial |
$3,505.92
|
| Rate for Payer: First Health Commercial |
$4,012.80
|
| Rate for Payer: Humana Commercial |
$3,590.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,463.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,117.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,267.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,717.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.44
|
| Rate for Payer: PHCS Commercial |
$4,055.04
|
| Rate for Payer: United Healthcare All Payer |
$3,717.12
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,224.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,055.04 |
| Rate for Payer: Aetna Commercial |
$3,252.48
|
| Rate for Payer: Anthem Medicaid |
$1,452.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,294.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cigna Commercial |
$3,505.92
|
| Rate for Payer: First Health Commercial |
$4,012.80
|
| Rate for Payer: Humana Commercial |
$3,590.40
|
| Rate for Payer: Humana KY Medicaid |
$1,452.63
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,467.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,463.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,117.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,717.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.44
|
| Rate for Payer: PHCS Commercial |
$4,055.04
|
| Rate for Payer: United Healthcare All Payer |
$3,717.12
|
|
|
MRI JOINT LWR EXTR W/O&W/DY(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
610P0039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,455.90 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,455.90
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
|
|
MRI JOINT LWR EXTR W/O&W/DY(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
610T0039
|
|
Hospital Revenue Code
|
610
|
| 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 JOINT LWR EXTR W/O&W/DY(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
610T0039
|
|
Hospital Revenue Code
|
610
|
| 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 JOINT OF LWR EXTR W/DYE
|
Facility
|
OP
|
$3,897.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$506.61 |
| Max. Negotiated Rate |
$3,741.12 |
| Rate for Payer: Aetna Commercial |
$3,000.69
|
| Rate for Payer: Anthem Medicaid |
$1,340.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,039.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,948.50
|
| Rate for Payer: Cash Price |
$1,948.50
|
| Rate for Payer: Cigna Commercial |
$3,234.51
|
| Rate for Payer: First Health Commercial |
$3,702.15
|
| Rate for Payer: Humana Commercial |
$3,312.45
|
| Rate for Payer: Humana KY Medicaid |
$1,340.18
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,353.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,195.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,875.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,367.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,429.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,922.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$779.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.07
|
| Rate for Payer: PHCS Commercial |
$3,741.12
|
| Rate for Payer: United Healthcare All Payer |
$3,429.36
|
|
