|
MRI LUMBAR SPINE W WO CONTRA(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
610P0022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$1,498.19 |
| Rate for Payer: Aetna Commercial |
$1,006.26
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| 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 |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
|
|
MRI LUMBAR SPINE W WO CONTRA(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
610T0022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$519.87 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI LUMBAR SPINE W WO CONTRA(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
610T0022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem Medicaid |
$1,375.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Humana KY Medicaid |
$1,375.26
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI LWR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$4,274.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,103.04 |
| Rate for Payer: Aetna Commercial |
$3,290.98
|
| Rate for Payer: Anthem Medicaid |
$1,469.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$3,547.42
|
| Rate for Payer: First Health Commercial |
$4,060.30
|
| Rate for Payer: Humana Commercial |
$3,632.90
|
| Rate for Payer: Humana KY Medicaid |
$1,469.83
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.94
|
| Rate for Payer: PHCS Commercial |
$4,103.04
|
| Rate for Payer: United Healthcare All Payer |
$3,761.12
|
|
|
MRI LWR EXTREMITY W/O&W/DYE
|
Professional
|
Both
|
$4,274.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$4,274.00 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,274.00
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$1,474.11
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,991.80
|
| Rate for Payer: UHCCP Medicaid |
$1,495.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI LWR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$4,274.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$555.62 |
| Max. Negotiated Rate |
$4,103.04 |
| Rate for Payer: Aetna Commercial |
$3,290.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.72
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$3,547.42
|
| Rate for Payer: First Health Commercial |
$4,060.30
|
| Rate for Payer: Humana Commercial |
$3,632.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.94
|
| Rate for Payer: PHCS Commercial |
$4,103.04
|
| Rate for Payer: United Healthcare All Payer |
$3,761.12
|
|
|
MRI LWR EXTREMITY W/O&W/DYE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
610P0036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$1,474.11 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$1,474.11
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
610T0036
|
|
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 LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
610T0036
|
|
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 NEEDLE PLACE BREAST
|
Professional
|
Both
|
$2,690.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$97.27 |
| Max. Negotiated Rate |
$2,690.00 |
| Rate for Payer: Aetna Commercial |
$682.33
|
| Rate for Payer: Anthem Medicaid |
$340.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,690.00
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna Commercial |
$726.96
|
| Rate for Payer: Healthspan PPO |
$639.36
|
| Rate for Payer: Humana Medicaid |
$340.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$347.37
|
| Rate for Payer: Molina Healthcare Passport |
$340.56
|
| Rate for Payer: Multiplan PHCS |
$1,614.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,883.00
|
| Rate for Payer: UHCCP Medicaid |
$941.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.97
|
|
|
MRI NEEDLE PLACE BREAST
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$349.70 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,071.30
|
| Rate for Payer: Anthem Medicaid |
$925.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,098.20
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna Commercial |
$2,232.70
|
| Rate for Payer: First Health Commercial |
$2,555.50
|
| Rate for Payer: Humana Commercial |
$2,286.50
|
| Rate for Payer: Humana KY Medicaid |
$925.09
|
| Rate for Payer: Kentucky WC Medicaid |
$934.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,205.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,985.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$943.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,367.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,017.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$833.90
|
| Rate for Payer: PHCS Commercial |
$2,582.40
|
| Rate for Payer: United Healthcare All Payer |
$2,367.20
|
|
|
MRI NEEDLE PLACE BREAST
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$349.70 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,071.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,098.20
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna Commercial |
$2,232.70
|
| Rate for Payer: First Health Commercial |
$2,555.50
|
| Rate for Payer: Humana Commercial |
$2,286.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,205.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,985.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,367.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,017.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$833.90
|
| Rate for Payer: PHCS Commercial |
$2,582.40
|
| Rate for Payer: United Healthcare All Payer |
$2,367.20
|
|
|
MRI NEEDLE PLACE BREAST(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
610P0048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$726.96 |
| Rate for Payer: Aetna Commercial |
$682.33
|
| Rate for Payer: Anthem Medicaid |
$340.56
|
| 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 |
$726.96
|
| Rate for Payer: Healthspan PPO |
$639.36
|
| Rate for Payer: Humana Medicaid |
$340.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$347.37
|
| Rate for Payer: Molina Healthcare Passport |
$340.56
|
| 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 |
$343.97
|
|
|
MRI NEEDLE PLACE BREAST(T
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
610T0048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$326.95 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.65
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
MRI NEEDLE PLACE BREAST(T
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
610T0048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$326.95 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem Medicaid |
$864.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Humana KY Medicaid |
$864.91
|
| Rate for Payer: Kentucky WC Medicaid |
$873.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.65
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
MRI PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Humana KY Medicaid |
$1,281.03
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,306.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,154.75
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
MRI PELVIS W/CONTRAST
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,117.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,154.75
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
MRI PELVIS W/CONTRAST
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$3,725.00 |
| Rate for Payer: Aetna Commercial |
$781.28
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,725.00
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$908.04
|
| Rate for Payer: Healthspan PPO |
$536.86
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$2,235.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,607.50
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
|
|
MRI PELVIS W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
610P0055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$908.04 |
| Rate for Payer: Aetna Commercial |
$781.28
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| 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 |
$908.04
|
| Rate for Payer: Healthspan PPO |
$536.86
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| 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 |
$375.39
|
|
|
MRI PELVIS W/CONTRAST(T
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
610T0055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
MRI PELVIS W/CONTRAST(T
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
610T0055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
MRI PELVIS WO CONTRAST
|
Facility
|
OP
|
$3,604.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
61000024
|
|
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 PELVIS WO CONTRAST
|
Professional
|
Both
|
$3,604.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
61000024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$3,604.00 |
| Rate for Payer: Aetna Commercial |
$639.05
|
| Rate for Payer: Anthem Medicaid |
$357.63
|
| 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 |
$778.44
|
| Rate for Payer: Healthspan PPO |
$439.12
|
| Rate for Payer: Humana Medicaid |
$357.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.78
|
| Rate for Payer: Molina Healthcare Passport |
$357.63
|
| 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 |
$361.21
|
|
|
MRI PELVIS WO CONTRAST
|
Facility
|
IP
|
$3,604.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
61000024
|
|
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 PELVIS WO CONTRAST(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
610P0024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$778.44 |
| Rate for Payer: Aetna Commercial |
$639.05
|
| Rate for Payer: Anthem Medicaid |
$357.63
|
| 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 |
$778.44
|
| Rate for Payer: Healthspan PPO |
$439.12
|
| Rate for Payer: Humana Medicaid |
$357.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.78
|
| Rate for Payer: Molina Healthcare Passport |
$357.63
|
| 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 |
$361.21
|
|
