|
MRI LOWER EXTREMITY W/DYE
|
Professional
|
Both
|
$3,822.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$3,822.00 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,822.00
|
| Rate for Payer: Cash Price |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,911.00
|
| Rate for Payer: Cigna Commercial |
$895.43
|
| 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 |
$2,293.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,675.40
|
| Rate for Payer: UHCCP Medicaid |
$1,337.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
|
MRI LOWER EXTREMITY W/DYE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
610P0035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$895.43 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| 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 |
$895.43
|
| 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 |
$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 |
$403.60
|
|
|
MRI LOWER EXTREMITY W/DYE(T
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
610T0035
|
|
Hospital Revenue Code
|
610
|
| 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 LOWER EXTREMITY W/DYE(T
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
610T0035
|
|
Hospital Revenue Code
|
610
|
| 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 LOWER EXTREMITY W/O DYE
|
Professional
|
Both
|
$3,604.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$3,604.00 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Anthem Medicaid |
$333.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,604.00
|
| Rate for Payer: Cash Price |
$1,802.00
|
| Rate for Payer: Cash Price |
$1,802.00
|
| Rate for Payer: Cigna Commercial |
$766.37
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$333.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.20
|
| Rate for Payer: Molina Healthcare Passport |
$333.53
|
| Rate for Payer: Multiplan PHCS |
$2,162.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,522.80
|
| Rate for Payer: UHCCP Medicaid |
$1,261.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.87
|
|
|
MRI LOWER EXTREMITY W/O DYE
|
Facility
|
OP
|
$3,604.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,459.84 |
| Rate for Payer: Aetna Commercial |
$2,775.08
|
| Rate for Payer: Anthem Medicaid |
$1,239.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,802.00
|
| Rate for Payer: Cash Price |
$1,802.00
|
| Rate for Payer: Cigna Commercial |
$2,991.32
|
| Rate for Payer: First Health Commercial |
$3,423.80
|
| Rate for Payer: Humana Commercial |
$3,063.40
|
| Rate for Payer: Humana KY Medicaid |
$1,239.42
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,252.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,955.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.24
|
| Rate for Payer: PHCS Commercial |
$3,459.84
|
| Rate for Payer: United Healthcare All Payer |
$3,171.52
|
|
|
MRI LOWER EXTREMITY W/O DYE
|
Facility
|
IP
|
$3,604.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$468.52 |
| Max. Negotiated Rate |
$3,459.84 |
| Rate for Payer: Aetna Commercial |
$2,775.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.12
|
| Rate for Payer: Cash Price |
$1,802.00
|
| Rate for Payer: Cigna Commercial |
$2,991.32
|
| Rate for Payer: First Health Commercial |
$3,423.80
|
| Rate for Payer: Humana Commercial |
$3,063.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,955.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.24
|
| Rate for Payer: PHCS Commercial |
$3,459.84
|
| Rate for Payer: United Healthcare All Payer |
$3,171.52
|
|
|
MRI LOWER EXTREMITY W/O DYE(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
610P0034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$766.37 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Anthem Medicaid |
$333.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$766.37
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$333.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.20
|
| Rate for Payer: Molina Healthcare Passport |
$333.53
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.87
|
|
|
MRI LOWER EXTREMITY W/O DYE(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
610T0034
|
|
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 LOWER EXTREMITY W/O DYE(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
610T0034
|
|
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 LUMBAR SPINE W/CONTRAST
|
Facility
|
IP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W/CONTRAST
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$3,872.00 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| 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 |
$923.35
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| 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 |
$444.27
|
|
|
MRI LUMBAR SPINE W/CONTRAST
|
Facility
|
OP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
610P0019
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$923.35 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| 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 |
$923.35
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| 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 |
$444.27
|
|
|
MRI LUMBAR SPINE W/CONTRAST(T
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
610T0019
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W/CONTRAST(T
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
610T0019
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W/O CONTRAS(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
610P0018
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$816.86 |
| Rate for Payer: Aetna Commercial |
$644.44
|
| Rate for Payer: Anthem Medicaid |
$399.65
|
| 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 |
$816.86
|
| Rate for Payer: Healthspan PPO |
$442.83
|
| Rate for Payer: Humana Medicaid |
$399.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.64
|
| Rate for Payer: Molina Healthcare Passport |
$399.65
|
| 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 |
$403.65
|
|
|
MRI LUMBAR SPINE W/O CONTRAS(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
610T0018
|
|
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 LUMBAR SPINE W/O CONTRAS(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
610T0018
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W/O CONTRAST
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$644.44
|
| Rate for Payer: Anthem Medicaid |
$399.65
|
| 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 |
$816.86
|
| Rate for Payer: Healthspan PPO |
$442.83
|
| Rate for Payer: Humana Medicaid |
$399.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.64
|
| Rate for Payer: Molina Healthcare Passport |
$399.65
|
| 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 |
$403.65
|
|
|
MRI LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
612
|
| 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 LUMBAR SPINE W WO CONTRA
|
Professional
|
Both
|
$4,349.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$151.28 |
| Max. Negotiated Rate |
$4,349.00 |
| Rate for Payer: Aetna Commercial |
$1,006.26
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,349.00
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$1,498.19
|
| Rate for Payer: Healthspan PPO |
$691.45
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$151.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$2,609.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,044.30
|
| Rate for Payer: UHCCP Medicaid |
$1,522.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
|
|
MRI LUMBAR SPINE W WO CONTRA
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem Medicaid |
$1,495.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Humana KY Medicaid |
$1,495.62
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,510.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,525.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.19
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
MRI LUMBAR SPINE W WO CONTRA
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$565.37 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.19
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
