|
MRI JOINT OF LWR EXTR W/DYE
|
Professional
|
Both
|
$3,897.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$3,897.00 |
| Rate for Payer: Aetna Commercial |
$771.72
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,897.00
|
| Rate for Payer: Cash Price |
$1,948.50
|
| Rate for Payer: Cash Price |
$1,948.50
|
| Rate for Payer: Cigna Commercial |
$886.05
|
| Rate for Payer: Healthspan PPO |
$530.29
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,338.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,727.90
|
| Rate for Payer: UHCCP Medicaid |
$1,363.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$3,039.66
|
| 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: 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 |
$1,169.10
|
| 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
|
|
|
MRI JOINT OF LWR EXTR W/DYE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
610P0038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$886.05 |
| Rate for Payer: Aetna Commercial |
$771.72
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$886.05
|
| Rate for Payer: Healthspan PPO |
$530.29
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI JOINT OF LWR EXTR W/DYE(T
|
Facility
|
OP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
610T0038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.61 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem Medicaid |
$1,271.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Humana KY Medicaid |
$1,271.40
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,296.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.07
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI JOINT OF LWR EXTR W/DYE(T
|
Facility
|
IP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
610T0038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.61 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.07
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
IP
|
$3,982.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$517.66 |
| Max. Negotiated Rate |
$3,822.72 |
| Rate for Payer: Aetna Commercial |
$3,066.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.96
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cigna Commercial |
$3,305.06
|
| Rate for Payer: First Health Commercial |
$3,782.90
|
| Rate for Payer: Humana Commercial |
$3,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,265.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,504.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.42
|
| Rate for Payer: PHCS Commercial |
$3,822.72
|
| Rate for Payer: United Healthcare All Payer |
$3,504.16
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
610P0058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$882.75 |
| Rate for Payer: Aetna Commercial |
$771.35
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$882.75
|
| Rate for Payer: Healthspan PPO |
$530.04
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.50
|
| Rate for Payer: UHCCP Medicaid |
$99.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
OP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
610T0058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.61 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem Medicaid |
$1,271.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Humana KY Medicaid |
$1,271.40
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,296.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.07
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
IP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
610T0058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$480.61 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.07
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
OP
|
$3,982.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$517.66 |
| Max. Negotiated Rate |
$3,822.72 |
| Rate for Payer: Aetna Commercial |
$3,066.14
|
| Rate for Payer: Anthem Medicaid |
$1,369.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cigna Commercial |
$3,305.06
|
| Rate for Payer: First Health Commercial |
$3,782.90
|
| Rate for Payer: Humana Commercial |
$3,384.70
|
| Rate for Payer: Humana KY Medicaid |
$1,369.41
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,265.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,504.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.42
|
| Rate for Payer: PHCS Commercial |
$3,822.72
|
| Rate for Payer: United Healthcare All Payer |
$3,504.16
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Professional
|
Both
|
$3,982.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$103.51 |
| Max. Negotiated Rate |
$3,982.00 |
| Rate for Payer: Aetna Commercial |
$771.35
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,982.00
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cash Price |
$1,991.00
|
| Rate for Payer: Cigna Commercial |
$882.75
|
| Rate for Payer: Healthspan PPO |
$530.04
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,787.40
|
| Rate for Payer: UHCCP Medicaid |
$1,393.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
OP
|
$3,629.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,483.84 |
| Rate for Payer: Aetna Commercial |
$2,794.33
|
| Rate for Payer: Anthem Medicaid |
$1,248.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,830.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,814.50
|
| Rate for Payer: Cash Price |
$1,814.50
|
| Rate for Payer: Cigna Commercial |
$3,012.07
|
| Rate for Payer: First Health Commercial |
$3,447.55
|
| Rate for Payer: Humana Commercial |
$3,084.65
|
| Rate for Payer: Humana KY Medicaid |
$1,248.01
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,975.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,678.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,273.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,193.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,721.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.99
|
| Rate for Payer: PHCS Commercial |
$3,483.84
|
| Rate for Payer: United Healthcare All Payer |
$3,193.52
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
IP
|
$3,629.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$471.77 |
| Max. Negotiated Rate |
$3,483.84 |
| Rate for Payer: Aetna Commercial |
$2,794.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,830.62
|
| Rate for Payer: Cash Price |
$1,814.50
|
| Rate for Payer: Cigna Commercial |
$3,012.07
|
| Rate for Payer: First Health Commercial |
$3,447.55
|
| Rate for Payer: Humana Commercial |
$3,084.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,975.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,678.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,193.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,721.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.99
|
| Rate for Payer: PHCS Commercial |
$3,483.84
|
| Rate for Payer: United Healthcare All Payer |
$3,193.52
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Professional
|
Both
|
$3,629.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.62 |
| Max. Negotiated Rate |
$3,629.00 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Anthem Medicaid |
$338.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,629.00
|
| Rate for Payer: Cash Price |
$1,814.50
|
| Rate for Payer: Cash Price |
$1,814.50
|
| Rate for Payer: Cigna Commercial |
$757.55
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$338.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.41
|
| Rate for Payer: Molina Healthcare Passport |
$338.64
|
| Rate for Payer: Multiplan PHCS |
$2,177.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,540.30
|
| Rate for Payer: UHCCP Medicaid |
$1,270.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.03
|
|
|
MRI JOINT UPR EXTREM W/O DY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
610P0030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$757.55 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Anthem Medicaid |
$338.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$757.55
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$338.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.41
|
| Rate for Payer: Molina Healthcare Passport |
$338.64
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.03
|
|
|
MRI JOINT UPR EXTREM W/O DY(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
610T0030
|
|
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 UPR EXTREM W/O DY(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
610T0030
|
|
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 JOINT UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,114.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,949.44 |
| Rate for Payer: Aetna Commercial |
$3,167.78
|
| Rate for Payer: Anthem Medicaid |
$1,414.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,208.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$3,414.62
|
| Rate for Payer: First Health Commercial |
$3,908.30
|
| Rate for Payer: Humana Commercial |
$3,496.90
|
| Rate for Payer: Humana KY Medicaid |
$1,414.80
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.34
|
| Rate for Payer: PHCS Commercial |
$3,949.44
|
| Rate for Payer: United Healthcare All Payer |
$3,620.32
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,114.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$534.82 |
| Max. Negotiated Rate |
$3,949.44 |
| Rate for Payer: Aetna Commercial |
$3,167.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,208.92
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$3,414.62
|
| Rate for Payer: First Health Commercial |
$3,908.30
|
| Rate for Payer: Humana Commercial |
$3,496.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.34
|
| Rate for Payer: PHCS Commercial |
$3,949.44
|
| Rate for Payer: United Healthcare All Payer |
$3,620.32
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Professional
|
Both
|
$4,114.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,114.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$1,456.47
|
| 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 |
$2,468.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,879.80
|
| Rate for Payer: UHCCP Medicaid |
$1,439.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
|
|
MRI JOINT UPR EXTR W/O&W/DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
610P0032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,456.47 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| 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 |
$1,456.47
|
| 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 |
$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 |
$723.84
|
|
|
MRI JOINT UPR EXTR W/O&W/DY(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
610T0032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRI JOINT UPR EXTR W/O&W/DY(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
610T0032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRI LOWER EXTREMITY W/DYE
|
Facility
|
OP
|
$3,822.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,669.12 |
| Rate for Payer: Aetna Commercial |
$2,942.94
|
| Rate for Payer: Anthem Medicaid |
$1,314.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,981.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,911.00
|
| Rate for Payer: Cigna Commercial |
$3,172.26
|
| Rate for Payer: First Health Commercial |
$3,630.90
|
| Rate for Payer: Humana Commercial |
$3,248.70
|
| Rate for Payer: Humana KY Medicaid |
$1,314.39
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,327.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,134.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,820.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,340.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,363.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,866.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$496.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,184.82
|
| Rate for Payer: PHCS Commercial |
$3,669.12
|
| Rate for Payer: United Healthcare All Payer |
$3,363.36
|
|
|
MRI LOWER EXTREMITY W/DYE
|
Facility
|
IP
|
$3,822.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$496.86 |
| Max. Negotiated Rate |
$3,669.12 |
| Rate for Payer: Aetna Commercial |
$2,942.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,981.16
|
| Rate for Payer: Cash Price |
$1,911.00
|
| Rate for Payer: Cigna Commercial |
$3,172.26
|
| Rate for Payer: First Health Commercial |
$3,630.90
|
| Rate for Payer: Humana Commercial |
$3,248.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,134.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,820.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,146.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,363.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,866.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$496.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,184.82
|
| Rate for Payer: PHCS Commercial |
$3,669.12
|
| Rate for Payer: United Healthcare All Payer |
$3,363.36
|
|
