|
MRI CERVICAL SPINE W CONTRAS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
610P0015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$933.24 |
| Rate for Payer: Aetna Commercial |
$798.63
|
| Rate for Payer: Ambetter Exchange |
$252.58
|
| Rate for Payer: Anthem Medicaid |
$445.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$252.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$252.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.10
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$933.24
|
| Rate for Payer: Healthspan PPO |
$548.78
|
| Rate for Payer: Humana Medicaid |
$445.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$252.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.58
|
| 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 |
$328.35
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.58
|
|
|
MRI CERVICAL SPINE W CONTRAS(T
|
Facility
|
IP
|
$3,804.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
610T0015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$3,651.84 |
| Rate for Payer: Aetna Commercial |
$2,929.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,967.12
|
| Rate for Payer: Cash Price |
$1,902.00
|
| Rate for Payer: Cigna Commercial |
$3,157.32
|
| Rate for Payer: First Health Commercial |
$3,613.80
|
| Rate for Payer: Humana Commercial |
$3,233.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,853.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.76
|
| Rate for Payer: PHCS Commercial |
$3,651.84
|
| Rate for Payer: United Healthcare All Payer |
$3,347.52
|
|
|
MRI CERVICAL SPINE W CONTRAS(T
|
Facility
|
OP
|
$3,804.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
610T0015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,651.84 |
| Rate for Payer: Aetna Commercial |
$2,929.08
|
| Rate for Payer: Anthem Medicaid |
$1,308.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,967.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,902.00
|
| Rate for Payer: Cash Price |
$1,902.00
|
| Rate for Payer: Cigna Commercial |
$3,157.32
|
| Rate for Payer: First Health Commercial |
$3,613.80
|
| Rate for Payer: Humana Commercial |
$3,233.40
|
| Rate for Payer: Humana KY Medicaid |
$1,308.20
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,853.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.76
|
| Rate for Payer: PHCS Commercial |
$3,651.84
|
| Rate for Payer: United Healthcare All Payer |
$3,347.52
|
|
|
MRI CERVICAL SPINE W CONTRAST
|
Professional
|
Both
|
$4,104.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$798.63
|
| Rate for Payer: Ambetter Exchange |
$252.58
|
| Rate for Payer: Anthem Medicaid |
$445.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$252.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$252.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.10
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$933.24
|
| Rate for Payer: Healthspan PPO |
$548.78
|
| Rate for Payer: Humana Medicaid |
$445.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$252.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
| Rate for Payer: Molina Healthcare Passport |
$445.83
|
| Rate for Payer: Multiplan PHCS |
$2,462.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$328.35
|
| Rate for Payer: UHCCP Medicaid |
$1,436.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.58
|
|
|
MRI CERVICAL SPINE W CONTRAST
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,939.84 |
| Rate for Payer: Aetna Commercial |
$3,160.08
|
| Rate for Payer: Anthem Medicaid |
$1,411.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$3,406.32
|
| Rate for Payer: First Health Commercial |
$3,898.80
|
| Rate for Payer: Humana Commercial |
$3,488.40
|
| Rate for Payer: Humana KY Medicaid |
$1,411.37
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,570.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.76
|
| Rate for Payer: PHCS Commercial |
$3,939.84
|
| Rate for Payer: United Healthcare All Payer |
$3,611.52
|
|
|
MRI CERVICAL SPINE W CONTRAST
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,231.20 |
| Max. Negotiated Rate |
$3,939.84 |
| Rate for Payer: Aetna Commercial |
$3,160.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.12
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$3,406.32
|
| Rate for Payer: First Health Commercial |
$3,898.80
|
| Rate for Payer: Humana Commercial |
$3,488.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,570.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.76
|
| Rate for Payer: PHCS Commercial |
$3,939.84
|
| Rate for Payer: United Healthcare All Payer |
$3,611.52
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
610P0014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$770.90 |
| Rate for Payer: Aetna Commercial |
$653.15
|
| Rate for Payer: Ambetter Exchange |
$175.53
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.64
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$770.90
|
| Rate for Payer: Healthspan PPO |
$448.81
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.19
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.53
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$653.15
|
| Rate for Payer: Ambetter Exchange |
$175.53
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.64
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$770.90
|
| Rate for Payer: Healthspan PPO |
$448.81
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.19
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.53
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,170.60 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.38
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem Medicaid |
$1,341.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Humana KY Medicaid |
$1,341.90
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.38
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
610T0014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
610T0014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem Medicaid |
$1,255.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Humana KY Medicaid |
$1,255.92
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MRI CERVICAL SPINE W/WO DYE
|
Professional
|
Both
|
$4,559.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$164.14 |
| Max. Negotiated Rate |
$2,735.40 |
| Rate for Payer: Aetna Commercial |
$1,023.39
|
| Rate for Payer: Ambetter Exchange |
$294.24
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$353.09
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$1,513.81
|
| Rate for Payer: Healthspan PPO |
$703.22
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$2,735.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$382.51
|
| Rate for Payer: UHCCP Medicaid |
$1,595.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.24
|
|
|
MRI CERVICAL SPINE W/WO DYE
|
Facility
|
IP
|
$4,559.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,367.70 |
| Max. Negotiated Rate |
$4,376.64 |
| Rate for Payer: Aetna Commercial |
$3,510.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,556.02
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$3,783.97
|
| Rate for Payer: First Health Commercial |
$4,331.05
|
| Rate for Payer: Humana Commercial |
$3,875.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,738.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,364.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,011.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,966.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,145.71
|
| Rate for Payer: PHCS Commercial |
$4,376.64
|
| Rate for Payer: United Healthcare All Payer |
$4,011.92
|
|
|
MRI CERVICAL SPINE W/WO DYE
|
Facility
|
OP
|
$4,559.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,376.64 |
| Rate for Payer: Aetna Commercial |
$3,510.43
|
| Rate for Payer: Anthem Medicaid |
$1,567.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,556.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$3,783.97
|
| Rate for Payer: First Health Commercial |
$4,331.05
|
| Rate for Payer: Humana Commercial |
$3,875.15
|
| Rate for Payer: Humana KY Medicaid |
$1,567.84
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,583.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,738.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,364.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,599.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,011.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,966.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,145.71
|
| Rate for Payer: PHCS Commercial |
$4,376.64
|
| Rate for Payer: United Healthcare All Payer |
$4,011.92
|
|
|
MRI CERVICAL SPINE W/WO DYE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
610P0020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$1,513.81 |
| Rate for Payer: Aetna Commercial |
$1,023.39
|
| Rate for Payer: Ambetter Exchange |
$294.24
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$353.09
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$1,513.81
|
| Rate for Payer: Healthspan PPO |
$703.22
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$382.51
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.24
|
|
|
MRI CERVICAL SPINE W/WO DYE(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
610T0020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,277.70 |
| Max. Negotiated Rate |
$4,088.64 |
| Rate for Payer: Aetna Commercial |
$3,279.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.02
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cigna Commercial |
$3,534.97
|
| Rate for Payer: First Health Commercial |
$4,046.05
|
| Rate for Payer: Humana Commercial |
$3,620.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,705.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.71
|
| Rate for Payer: PHCS Commercial |
$4,088.64
|
| Rate for Payer: United Healthcare All Payer |
$3,747.92
|
|
|
MRI CERVICAL SPINE W/WO DYE(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
610T0020
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,088.64 |
| Rate for Payer: Aetna Commercial |
$3,279.43
|
| Rate for Payer: Anthem Medicaid |
$1,464.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cigna Commercial |
$3,534.97
|
| Rate for Payer: First Health Commercial |
$4,046.05
|
| Rate for Payer: Humana Commercial |
$3,620.15
|
| Rate for Payer: Humana KY Medicaid |
$1,464.67
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,705.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.71
|
| Rate for Payer: PHCS Commercial |
$4,088.64
|
| Rate for Payer: United Healthcare All Payer |
$3,747.92
|
|
|
MRI CHEST W/CONTRAST
|
Facility
|
IP
|
$4,215.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
61000054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,264.50 |
| Max. Negotiated Rate |
$4,046.40 |
| Rate for Payer: Aetna Commercial |
$3,245.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,287.70
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cigna Commercial |
$3,498.45
|
| Rate for Payer: First Health Commercial |
$4,004.25
|
| Rate for Payer: Humana Commercial |
$3,582.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,456.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,110.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,709.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,667.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,908.35
|
| Rate for Payer: PHCS Commercial |
$4,046.40
|
| Rate for Payer: United Healthcare All Payer |
$3,709.20
|
|
|
MRI CHEST W/CONTRAST
|
Professional
|
Both
|
$4,215.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
61000054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Aetna Commercial |
$779.50
|
| Rate for Payer: Ambetter Exchange |
$339.87
|
| Rate for Payer: Anthem Medicaid |
$405.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$339.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$339.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$407.84
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cigna Commercial |
$940.01
|
| Rate for Payer: Healthspan PPO |
$535.63
|
| Rate for Payer: Humana Medicaid |
$405.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$339.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.73
|
| Rate for Payer: Molina Healthcare Passport |
$405.62
|
| Rate for Payer: Multiplan PHCS |
$2,529.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.83
|
| Rate for Payer: UHCCP Medicaid |
$1,475.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$339.87
|
|
|
MRI CHEST W/CONTRAST
|
Facility
|
OP
|
$4,215.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
61000054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$4,046.40 |
| Rate for Payer: Aetna Commercial |
$3,245.55
|
| Rate for Payer: Anthem Medicaid |
$1,449.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,287.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cash Price |
$2,107.50
|
| Rate for Payer: Cigna Commercial |
$3,498.45
|
| Rate for Payer: First Health Commercial |
$4,004.25
|
| Rate for Payer: Humana Commercial |
$3,582.75
|
| Rate for Payer: Humana KY Medicaid |
$1,449.54
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,464.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,456.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,110.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,478.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,709.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,667.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,908.35
|
| Rate for Payer: PHCS Commercial |
$4,046.40
|
| Rate for Payer: United Healthcare All Payer |
$3,709.20
|
|
|
MRI CHEST W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
610P0054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$940.01 |
| Rate for Payer: Aetna Commercial |
$779.50
|
| Rate for Payer: Ambetter Exchange |
$339.87
|
| Rate for Payer: Anthem Medicaid |
$405.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$339.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$339.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$407.84
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$940.01
|
| Rate for Payer: Healthspan PPO |
$535.63
|
| Rate for Payer: Humana Medicaid |
$405.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$339.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.73
|
| Rate for Payer: Molina Healthcare Passport |
$405.62
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.83
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$339.87
|
|
|
MRI CHEST W/CONTRAST(T
|
Facility
|
OP
|
$3,915.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
610T0054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem Medicaid |
$1,346.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,406.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.35
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
|
MRI CHEST W/CONTRAST(T
|
Facility
|
IP
|
$3,915.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
610T0054
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,174.50 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,406.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.35
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
|
MRI CROME HF QUAD IS4 DF4
|
Facility
|
IP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
