MRI THORACIC SPINE W AND WO(T
|
Facility
|
OP
|
$3,999.00
|
|
Service Code
|
HCPCS 72157
|
Hospital Charge Code |
610T0021
|
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 THORACIC SPINE W/CONTRAS(P
|
Professional
|
Both
|
$300.00
|
|
Service Code
|
HCPCS 72147
|
Hospital Charge Code |
610P0017
|
Hospital Revenue Code
|
612
|
Min. Negotiated Rate |
$105.00 |
Max. Negotiated Rate |
$905.67 |
Rate for Payer: Aetna Commercial |
$800.22
|
Rate for Payer: Anthem Medicaid |
$445.83
|
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 |
$905.67
|
Rate for Payer: Healthspan PPO |
$549.87
|
Rate for Payer: Humana Medicaid |
$445.83
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
Rate for Payer: Molina Healthcare Passport |
$445.83
|
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 |
$450.29
|
|
MRI THORACIC SPINE W/CONTRAS(T
|
Facility
|
OP
|
$3,572.00
|
|
Service Code
|
HCPCS 72147
|
Hospital Charge Code |
610T0017
|
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 THORACIC SPINE W/CONTRAS(T
|
Facility
|
IP
|
$3,572.00
|
|
Service Code
|
HCPCS 72147
|
Hospital Charge Code |
610T0017
|
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 THORACIC SPINE W/CONTRAST
|
Professional
|
Both
|
$3,872.00
|
|
Service Code
|
HCPCS 72147
|
Hospital Charge Code |
61000017
|
Hospital Revenue Code
|
612
|
Min. Negotiated Rate |
$122.45 |
Max. Negotiated Rate |
$3,872.00 |
Rate for Payer: Aetna Commercial |
$800.22
|
Rate for Payer: Anthem Medicaid |
$445.83
|
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 |
$905.67
|
Rate for Payer: Healthspan PPO |
$549.87
|
Rate for Payer: Humana Medicaid |
$445.83
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
Rate for Payer: Molina Healthcare Passport |
$445.83
|
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 |
$450.29
|
|
MRI THORACIC SPINE W/CONTRAST
|
Facility
|
IP
|
$3,872.00
|
|
Service Code
|
HCPCS 72147
|
Hospital Charge Code |
61000017
|
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 THORACIC SPINE W/CONTRAST
|
Facility
|
OP
|
$3,872.00
|
|
Service Code
|
HCPCS 72147
|
Hospital Charge Code |
61000017
|
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 THORACIC SPINE W/O CON
|
Professional
|
Both
|
$3,679.00
|
|
Service Code
|
HCPCS 72146
|
Hospital Charge Code |
61000016
|
Hospital Revenue Code
|
612
|
Min. Negotiated Rate |
$102.22 |
Max. Negotiated Rate |
$3,679.00 |
Rate for Payer: Aetna Commercial |
$654.05
|
Rate for Payer: Anthem Medicaid |
$405.02
|
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 |
$825.01
|
Rate for Payer: Healthspan PPO |
$449.43
|
Rate for Payer: Humana Medicaid |
$405.02
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.12
|
Rate for Payer: Molina Healthcare Passport |
$405.02
|
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 |
$409.07
|
|
MRI THORACIC SPINE W/O CON
|
Facility
|
OP
|
$3,679.00
|
|
Service Code
|
HCPCS 72146
|
Hospital Charge Code |
61000016
|
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 THORACIC SPINE W/O CON
|
Facility
|
IP
|
$3,679.00
|
|
Service Code
|
HCPCS 72146
|
Hospital Charge Code |
61000016
|
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 THORACIC SPINE W/O CON(P
|
Professional
|
Both
|
$250.00
|
|
Service Code
|
HCPCS 72146
|
Hospital Charge Code |
610P0016
|
Hospital Revenue Code
|
612
|
Min. Negotiated Rate |
$87.50 |
Max. Negotiated Rate |
$825.01 |
Rate for Payer: Aetna Commercial |
$654.05
|
Rate for Payer: Anthem Medicaid |
$405.02
|
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 |
$825.01
|
Rate for Payer: Healthspan PPO |
$449.43
|
Rate for Payer: Humana Medicaid |
$405.02
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.12
|
Rate for Payer: Molina Healthcare Passport |
$405.02
|
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 |
$409.07
|
|
MRI THORACIC SPINE W/O CON(T
|
Facility
|
IP
|
$3,429.00
|
|
Service Code
|
HCPCS 72146
|
Hospital Charge Code |
610T0016
|
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 THORACIC SPINE W/O CON(T
|
Facility
|
OP
|
$3,429.00
|
|
Service Code
|
HCPCS 72146
|
Hospital Charge Code |
610T0016
|
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 UPPER EXTREMITY W/DYE
|
Facility
|
OP
|
$3,811.00
|
|
Service Code
|
HCPCS 73219
|
Hospital Charge Code |
61000056
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$332.56 |
Max. Negotiated Rate |
$3,658.56 |
Rate for Payer: Aetna Commercial |
$2,934.47
|
Rate for Payer: Anthem Medicaid |
$1,310.60
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,972.58
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
Rate for Payer: Cash Price |
$1,905.50
|
Rate for Payer: Cash Price |
$1,905.50
|
Rate for Payer: Cigna Commercial |
$3,163.13
|
Rate for Payer: First Health Commercial |
$3,620.45
|
Rate for Payer: Humana Commercial |
$3,239.35
|
Rate for Payer: Humana KY Medicaid |
$1,310.60
|
Rate for Payer: Humana Medicare Advantage |
$332.56
|
Rate for Payer: Kentucky WC Medicaid |
$1,323.94
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,812.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
Rate for Payer: Molina Healthcare Medicaid |
$1,336.90
|
Rate for Payer: Ohio Health Choice Commercial |
$3,353.68
|
Rate for Payer: Ohio Health Group HMO |
$2,858.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$762.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$495.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.41
|
Rate for Payer: PHCS Commercial |
$3,658.56
|
Rate for Payer: United Healthcare All Payer |
$3,353.68
|
|
MRI UPPER EXTREMITY W/DYE
|
Facility
|
IP
|
$3,811.00
|
|
Service Code
|
HCPCS 73219
|
Hospital Charge Code |
61000056
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$495.43 |
Max. Negotiated Rate |
$3,658.56 |
Rate for Payer: Aetna Commercial |
$2,934.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,972.58
|
Rate for Payer: Cash Price |
$1,905.50
|
Rate for Payer: Cigna Commercial |
$3,163.13
|
Rate for Payer: First Health Commercial |
$3,620.45
|
Rate for Payer: Humana Commercial |
$3,239.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,812.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.30
|
Rate for Payer: Ohio Health Choice Commercial |
$3,353.68
|
Rate for Payer: Ohio Health Group HMO |
$2,858.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$762.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$495.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.41
|
Rate for Payer: PHCS Commercial |
$3,658.56
|
Rate for Payer: United Healthcare All Payer |
$3,353.68
|
|
MRI UPPER EXTREMITY W/DYE
|
Professional
|
Both
|
$3,811.00
|
|
Service Code
|
HCPCS 73219
|
Hospital Charge Code |
61000056
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$103.51 |
Max. Negotiated Rate |
$3,811.00 |
Rate for Payer: Aetna Commercial |
$771.55
|
Rate for Payer: Anthem Medicaid |
$399.60
|
Rate for Payer: Buckeye Medicare Advantage |
$3,811.00
|
Rate for Payer: Cash Price |
$1,905.50
|
Rate for Payer: Cash Price |
$1,905.50
|
Rate for Payer: Cigna Commercial |
$897.07
|
Rate for Payer: Healthspan PPO |
$530.17
|
Rate for Payer: Humana Medicaid |
$399.60
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
Rate for Payer: Molina Healthcare Passport |
$399.60
|
Rate for Payer: Multiplan PHCS |
$2,286.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,667.70
|
Rate for Payer: UHCCP Medicaid |
$1,333.85
|
Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
MRI UPPER EXTREMITY W/DYE(P
|
Professional
|
Both
|
$200.00
|
|
Service Code
|
HCPCS 73219
|
Hospital Charge Code |
610P0056
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$70.00 |
Max. Negotiated Rate |
$897.07 |
Rate for Payer: Aetna Commercial |
$771.55
|
Rate for Payer: Anthem Medicaid |
$399.60
|
Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
Rate for Payer: Cash Price |
$100.00
|
Rate for Payer: Cash Price |
$100.00
|
Rate for Payer: Cigna Commercial |
$897.07
|
Rate for Payer: Healthspan PPO |
$530.17
|
Rate for Payer: Humana Medicaid |
$399.60
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
Rate for Payer: Molina Healthcare Passport |
$399.60
|
Rate for Payer: Multiplan PHCS |
$120.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
Rate for Payer: UHCCP Medicaid |
$70.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
|
MRI UPPER EXTREMITY W/DYE(T
|
Facility
|
IP
|
$3,611.00
|
|
Service Code
|
HCPCS 73219
|
Hospital Charge Code |
610T0056
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$469.43 |
Max. Negotiated Rate |
$3,466.56 |
Rate for Payer: Aetna Commercial |
$2,780.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.58
|
Rate for Payer: Cash Price |
$1,805.50
|
Rate for Payer: Cigna Commercial |
$2,997.13
|
Rate for Payer: First Health Commercial |
$3,430.45
|
Rate for Payer: Humana Commercial |
$3,069.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.92
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.30
|
Rate for Payer: Ohio Health Choice Commercial |
$3,177.68
|
Rate for Payer: Ohio Health Group HMO |
$2,708.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$722.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$469.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,119.41
|
Rate for Payer: PHCS Commercial |
$3,466.56
|
Rate for Payer: United Healthcare All Payer |
$3,177.68
|
|
MRI UPPER EXTREMITY W/DYE(T
|
Facility
|
OP
|
$3,611.00
|
|
Service Code
|
HCPCS 73219
|
Hospital Charge Code |
610T0056
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$332.56 |
Max. Negotiated Rate |
$3,466.56 |
Rate for Payer: Aetna Commercial |
$2,780.47
|
Rate for Payer: Anthem Medicaid |
$1,241.82
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.58
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
Rate for Payer: Cash Price |
$1,805.50
|
Rate for Payer: Cash Price |
$1,805.50
|
Rate for Payer: Cigna Commercial |
$2,997.13
|
Rate for Payer: First Health Commercial |
$3,430.45
|
Rate for Payer: Humana Commercial |
$3,069.35
|
Rate for Payer: Humana KY Medicaid |
$1,241.82
|
Rate for Payer: Humana Medicare Advantage |
$332.56
|
Rate for Payer: Kentucky WC Medicaid |
$1,254.46
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.92
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
Rate for Payer: Molina Healthcare Medicaid |
$1,266.74
|
Rate for Payer: Ohio Health Choice Commercial |
$3,177.68
|
Rate for Payer: Ohio Health Group HMO |
$2,708.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$722.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$469.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,119.41
|
Rate for Payer: PHCS Commercial |
$3,466.56
|
Rate for Payer: United Healthcare All Payer |
$3,177.68
|
|
MRI UPPER EXTREMITY W/O DYE
|
Facility
|
IP
|
$3,604.00
|
|
Service Code
|
HCPCS 73218
|
Hospital Charge Code |
61000028
|
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 UPPER EXTREMITY W/O DYE
|
Facility
|
OP
|
$3,604.00
|
|
Service Code
|
HCPCS 73218
|
Hospital Charge Code |
61000028
|
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 UPPER EXTREMITY W/O DYE
|
Professional
|
Both
|
$3,604.00
|
|
Service Code
|
HCPCS 73218
|
Hospital Charge Code |
61000028
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$85.61 |
Max. Negotiated Rate |
$3,604.00 |
Rate for Payer: Aetna Commercial |
$629.14
|
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 |
$771.89
|
Rate for Payer: Healthspan PPO |
$432.31
|
Rate for Payer: Humana Medicaid |
$333.53
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.61
|
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 UPPER EXTREMITY W/O DYE(P
|
Professional
|
Both
|
$175.00
|
|
Service Code
|
HCPCS 73218
|
Hospital Charge Code |
610P0028
|
Hospital Revenue Code
|
610
|
Min. Negotiated Rate |
$61.25 |
Max. Negotiated Rate |
$771.89 |
Rate for Payer: Aetna Commercial |
$629.14
|
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 |
$771.89
|
Rate for Payer: Healthspan PPO |
$432.31
|
Rate for Payer: Humana Medicaid |
$333.53
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.61
|
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 UPPER EXTREMITY W/O DYE(T
|
Facility
|
OP
|
$3,429.00
|
|
Service Code
|
HCPCS 73218
|
Hospital Charge Code |
610T0028
|
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 UPPER EXTREMITY W/O DYE(T
|
Facility
|
IP
|
$3,429.00
|
|
Service Code
|
HCPCS 73218
|
Hospital Charge Code |
610T0028
|
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
|
|