|
MRI PELVIS WO CONTRAST(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
610T0024
|
|
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 PELVIS WO CONTRAST(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
610T0024
|
|
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 PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$4,249.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,079.04 |
| Rate for Payer: Aetna Commercial |
$3,271.73
|
| Rate for Payer: Anthem Medicaid |
$1,461.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$3,526.67
|
| Rate for Payer: First Health Commercial |
$4,036.55
|
| Rate for Payer: Humana Commercial |
$3,611.65
|
| Rate for Payer: Humana KY Medicaid |
$1,461.23
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.19
|
| Rate for Payer: PHCS Commercial |
$4,079.04
|
| Rate for Payer: United Healthcare All Payer |
$3,739.12
|
|
|
MRI PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$4,249.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$552.37 |
| Max. Negotiated Rate |
$4,079.04 |
| Rate for Payer: Aetna Commercial |
$3,271.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.22
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$3,526.67
|
| Rate for Payer: First Health Commercial |
$4,036.55
|
| Rate for Payer: Humana Commercial |
$3,611.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.19
|
| Rate for Payer: PHCS Commercial |
$4,079.04
|
| Rate for Payer: United Healthcare All Payer |
$3,739.12
|
|
|
MRI PELVIS W/WO CONTRAST
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$143.16 |
| Max. Negotiated Rate |
$4,249.00 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,249.00
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$1,485.09
|
| Rate for Payer: Healthspan PPO |
$682.63
|
| Rate for Payer: Humana Medicaid |
$723.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.96
|
| Rate for Payer: Molina Healthcare Passport |
$723.49
|
| Rate for Payer: Multiplan PHCS |
$2,549.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,974.30
|
| Rate for Payer: UHCCP Medicaid |
$1,487.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.72
|
|
|
MRI PELVIS W/WO CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
610P0025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,485.09 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| 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 |
$1,485.09
|
| Rate for Payer: Healthspan PPO |
$682.63
|
| Rate for Payer: Humana Medicaid |
$723.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.96
|
| Rate for Payer: Molina Healthcare Passport |
$723.49
|
| 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 |
$730.72
|
|
|
MRI PELVIS W/WO CONTRAST(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
610T0025
|
|
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 PELVIS W/WO CONTRAST(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
610T0025
|
|
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 QUAD COBAL CRTD DTPA2Q1
|
Facility
|
IP
|
$89,980.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,697.40 |
| Max. Negotiated Rate |
$86,380.80 |
| Rate for Payer: Aetna Commercial |
$69,284.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,184.40
|
| Rate for Payer: Cash Price |
$44,990.00
|
| Rate for Payer: Cigna Commercial |
$74,683.40
|
| Rate for Payer: First Health Commercial |
$85,481.00
|
| Rate for Payer: Humana Commercial |
$76,483.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73,783.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,405.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,994.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,182.40
|
| Rate for Payer: Ohio Health Group HMO |
$67,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,697.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,893.80
|
| Rate for Payer: PHCS Commercial |
$86,380.80
|
| Rate for Payer: United Healthcare All Payer |
$79,182.40
|
|
|
MRI QUAD COBAL CRTD DTPA2Q1
|
Facility
|
OP
|
$89,980.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,697.40 |
| Max. Negotiated Rate |
$86,380.80 |
| Rate for Payer: Aetna Commercial |
$69,284.60
|
| Rate for Payer: Anthem Medicaid |
$30,944.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,184.40
|
| Rate for Payer: Cash Price |
$44,990.00
|
| Rate for Payer: Cigna Commercial |
$74,683.40
|
| Rate for Payer: First Health Commercial |
$85,481.00
|
| Rate for Payer: Humana Commercial |
$76,483.00
|
| Rate for Payer: Humana KY Medicaid |
$30,944.12
|
| Rate for Payer: Kentucky WC Medicaid |
$31,259.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73,783.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,405.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,994.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,564.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,182.40
|
| Rate for Payer: Ohio Health Group HMO |
$67,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,697.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,893.80
|
| Rate for Payer: PHCS Commercial |
$86,380.80
|
| Rate for Payer: United Healthcare All Payer |
$79,182.40
|
|
|
MRI SURESCAN CRT-D DTPB2QQ
|
Facility
|
OP
|
$84,220.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,948.60 |
| Max. Negotiated Rate |
$80,851.20 |
| Rate for Payer: Aetna Commercial |
$64,849.40
|
| Rate for Payer: Anthem Medicaid |
$28,963.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,691.60
|
| Rate for Payer: Cash Price |
$42,110.00
|
| Rate for Payer: Cigna Commercial |
$69,902.60
|
| Rate for Payer: First Health Commercial |
$80,009.00
|
| Rate for Payer: Humana Commercial |
$71,587.00
|
| Rate for Payer: Humana KY Medicaid |
$28,963.26
|
| Rate for Payer: Kentucky WC Medicaid |
$29,258.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,060.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,154.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,266.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,544.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,113.60
|
| Rate for Payer: Ohio Health Group HMO |
$63,165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,844.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,948.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,108.20
|
| Rate for Payer: PHCS Commercial |
$80,851.20
|
| Rate for Payer: United Healthcare All Payer |
$74,113.60
|
|
|
MRI SURESCAN CRT-D DTPB2QQ
|
Facility
|
IP
|
$84,220.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,948.60 |
| Max. Negotiated Rate |
$80,851.20 |
| Rate for Payer: Aetna Commercial |
$64,849.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,691.60
|
| Rate for Payer: Cash Price |
$42,110.00
|
| Rate for Payer: Cigna Commercial |
$69,902.60
|
| Rate for Payer: First Health Commercial |
$80,009.00
|
| Rate for Payer: Humana Commercial |
$71,587.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,060.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,154.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,266.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$74,113.60
|
| Rate for Payer: Ohio Health Group HMO |
$63,165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,844.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,948.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,108.20
|
| Rate for Payer: PHCS Commercial |
$80,851.20
|
| Rate for Payer: United Healthcare All Payer |
$74,113.60
|
|
|
MRI SURESCAN CRT-P BATTERY
|
Facility
|
IP
|
$20,421.16
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,654.75 |
| Max. Negotiated Rate |
$19,604.31 |
| Rate for Payer: Aetna Commercial |
$15,724.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,928.50
|
| Rate for Payer: Cash Price |
$10,210.58
|
| Rate for Payer: Cigna Commercial |
$16,949.56
|
| Rate for Payer: First Health Commercial |
$19,400.10
|
| Rate for Payer: Humana Commercial |
$17,357.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,745.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,070.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,126.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,970.62
|
| Rate for Payer: Ohio Health Group HMO |
$15,315.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,084.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,654.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,330.56
|
| Rate for Payer: PHCS Commercial |
$19,604.31
|
| Rate for Payer: United Healthcare All Payer |
$17,970.62
|
|
|
MRI SURESCAN CRT-P BATTERY
|
Facility
|
OP
|
$20,421.16
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,654.75 |
| Max. Negotiated Rate |
$19,604.31 |
| Rate for Payer: Aetna Commercial |
$15,724.29
|
| Rate for Payer: Anthem Medicaid |
$7,022.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,928.50
|
| Rate for Payer: Cash Price |
$10,210.58
|
| Rate for Payer: Cigna Commercial |
$16,949.56
|
| Rate for Payer: First Health Commercial |
$19,400.10
|
| Rate for Payer: Humana Commercial |
$17,357.99
|
| Rate for Payer: Humana KY Medicaid |
$7,022.84
|
| Rate for Payer: Kentucky WC Medicaid |
$7,094.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,745.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,070.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,126.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,163.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,970.62
|
| Rate for Payer: Ohio Health Group HMO |
$15,315.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,084.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,654.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,330.56
|
| Rate for Payer: PHCS Commercial |
$19,604.31
|
| Rate for Payer: United Healthcare All Payer |
$17,970.62
|
|
|
MRI TEMPOROMANDIBULAR JOINT
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,420.48 |
| Rate for Payer: Aetna Commercial |
$2,743.51
|
| Rate for Payer: Anthem Medicaid |
$1,225.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,779.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cigna Commercial |
$2,957.29
|
| Rate for Payer: First Health Commercial |
$3,384.85
|
| Rate for Payer: Humana Commercial |
$3,028.55
|
| Rate for Payer: Humana KY Medicaid |
$1,225.32
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,237.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,921.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,629.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,249.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,135.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,672.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.53
|
| Rate for Payer: PHCS Commercial |
$3,420.48
|
| Rate for Payer: United Healthcare All Payer |
$3,135.44
|
|
|
MRI TEMPOROMANDIBULAR JOINT
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$463.19 |
| Max. Negotiated Rate |
$3,420.48 |
| Rate for Payer: Aetna Commercial |
$2,743.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,779.14
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cigna Commercial |
$2,957.29
|
| Rate for Payer: First Health Commercial |
$3,384.85
|
| Rate for Payer: Humana Commercial |
$3,028.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,921.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,629.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,135.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,672.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.53
|
| Rate for Payer: PHCS Commercial |
$3,420.48
|
| Rate for Payer: United Healthcare All Payer |
$3,135.44
|
|
|
MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
Both
|
$3,563.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.44 |
| Max. Negotiated Rate |
$3,563.00 |
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Anthem Medicaid |
$343.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,563.00
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cash Price |
$1,781.50
|
| Rate for Payer: Cigna Commercial |
$759.44
|
| Rate for Payer: Healthspan PPO |
$442.58
|
| Rate for Payer: Humana Medicaid |
$343.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.47
|
| Rate for Payer: Molina Healthcare Passport |
$343.60
|
| Rate for Payer: Multiplan PHCS |
$2,137.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,494.10
|
| Rate for Payer: UHCCP Medicaid |
$1,247.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.04
|
|
|
MRI TEMPOROMANDIBULAR JOINT(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
610P0001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$759.44 |
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Anthem Medicaid |
$343.60
|
| 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 |
$759.44
|
| Rate for Payer: Healthspan PPO |
$442.58
|
| Rate for Payer: Humana Medicaid |
$343.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.47
|
| Rate for Payer: Molina Healthcare Passport |
$343.60
|
| 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 |
$347.04
|
|
|
MRI TEMPOROMANDIBULAR JOINT(T
|
Facility
|
OP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
610T0001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,180.48 |
| Rate for Payer: Aetna Commercial |
$2,551.01
|
| Rate for Payer: Anthem Medicaid |
$1,139.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,656.50
|
| Rate for Payer: Cash Price |
$1,656.50
|
| Rate for Payer: Cigna Commercial |
$2,749.79
|
| Rate for Payer: First Health Commercial |
$3,147.35
|
| Rate for Payer: Humana Commercial |
$2,816.05
|
| Rate for Payer: Humana KY Medicaid |
$1,139.34
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.03
|
| Rate for Payer: PHCS Commercial |
$3,180.48
|
| Rate for Payer: United Healthcare All Payer |
$2,915.44
|
|
|
MRI TEMPOROMANDIBULAR JOINT(T
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
610T0001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$3,180.48 |
| Rate for Payer: Aetna Commercial |
$2,551.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.14
|
| Rate for Payer: Cash Price |
$1,656.50
|
| Rate for Payer: Cigna Commercial |
$2,749.79
|
| Rate for Payer: First Health Commercial |
$3,147.35
|
| Rate for Payer: Humana Commercial |
$2,816.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.03
|
| Rate for Payer: PHCS Commercial |
$3,180.48
|
| Rate for Payer: United Healthcare All Payer |
$2,915.44
|
|
|
MRI THORACIC SPINE W AND WO
|
Professional
|
Both
|
$4,324.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$164.14 |
| Max. Negotiated Rate |
$4,324.00 |
| Rate for Payer: Aetna Commercial |
$1,024.97
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,324.00
|
| Rate for Payer: Cash Price |
$2,162.00
|
| Rate for Payer: Cash Price |
$2,162.00
|
| Rate for Payer: Cigna Commercial |
$1,491.76
|
| Rate for Payer: Healthspan PPO |
$704.31
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$2,594.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,026.80
|
| Rate for Payer: UHCCP Medicaid |
$1,513.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
|
|
MRI THORACIC SPINE W AND WO
|
Facility
|
IP
|
$4,324.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$562.12 |
| Max. Negotiated Rate |
$4,151.04 |
| Rate for Payer: Aetna Commercial |
$3,329.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,372.72
|
| Rate for Payer: Cash Price |
$2,162.00
|
| Rate for Payer: Cigna Commercial |
$3,588.92
|
| Rate for Payer: First Health Commercial |
$4,107.80
|
| Rate for Payer: Humana Commercial |
$3,675.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,545.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,805.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.44
|
| Rate for Payer: PHCS Commercial |
$4,151.04
|
| Rate for Payer: United Healthcare All Payer |
$3,805.12
|
|
|
MRI THORACIC SPINE W AND WO
|
Facility
|
OP
|
$4,324.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,151.04 |
| Rate for Payer: Aetna Commercial |
$3,329.48
|
| Rate for Payer: Anthem Medicaid |
$1,487.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,372.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,162.00
|
| Rate for Payer: Cash Price |
$2,162.00
|
| Rate for Payer: Cigna Commercial |
$3,588.92
|
| Rate for Payer: First Health Commercial |
$4,107.80
|
| Rate for Payer: Humana Commercial |
$3,675.40
|
| Rate for Payer: Humana KY Medicaid |
$1,487.02
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,502.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,545.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,516.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,805.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.44
|
| Rate for Payer: PHCS Commercial |
$4,151.04
|
| Rate for Payer: United Healthcare All Payer |
$3,805.12
|
|
|
MRI THORACIC SPINE W AND WO(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
610P0021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$1,491.76 |
| Rate for Payer: Aetna Commercial |
$1,024.97
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$1,491.76
|
| Rate for Payer: Healthspan PPO |
$704.31
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
|
|
MRI THORACIC SPINE W AND WO(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
610T0021
|
|
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
|
|
