|
MRI JNT OF LWR EXTRE W/O DY(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
610T0037
|
|
Hospital Revenue Code
|
610
|
| 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 JNT OF LWR EXTRE W/O DY(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
610T0037
|
|
Hospital Revenue Code
|
610
|
| 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 JOINT LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,484.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,345.20 |
| Max. Negotiated Rate |
$4,304.64 |
| Rate for Payer: Aetna Commercial |
$3,452.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,497.52
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cigna Commercial |
$3,721.72
|
| Rate for Payer: First Health Commercial |
$4,259.80
|
| Rate for Payer: Humana Commercial |
$3,811.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,676.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,345.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,945.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,901.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,093.96
|
| Rate for Payer: PHCS Commercial |
$4,304.64
|
| Rate for Payer: United Healthcare All Payer |
$3,945.92
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,484.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,304.64 |
| Rate for Payer: Aetna Commercial |
$3,452.68
|
| Rate for Payer: Anthem Medicaid |
$1,542.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,497.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cigna Commercial |
$3,721.72
|
| Rate for Payer: First Health Commercial |
$4,259.80
|
| Rate for Payer: Humana Commercial |
$3,811.40
|
| Rate for Payer: Humana KY Medicaid |
$1,542.05
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,557.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,676.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,945.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,901.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,093.96
|
| Rate for Payer: PHCS Commercial |
$4,304.64
|
| Rate for Payer: United Healthcare All Payer |
$3,945.92
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Professional
|
Both
|
$4,484.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
61000039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$2,690.40 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$350.67
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$350.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$420.80
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cigna Commercial |
$1,455.90
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$350.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$2,690.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.87
|
| Rate for Payer: UHCCP Medicaid |
$1,569.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$350.67
|
|
|
MRI JOINT LWR EXTR W/O&W/DY(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
610P0039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,455.90 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$350.67
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$350.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$420.80
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,455.90
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$350.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.87
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$350.67
|
|
|
MRI JOINT LWR EXTR W/O&W/DY(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
610T0039
|
|
Hospital Revenue Code
|
610
|
| 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 JOINT LWR EXTR W/O&W/DY(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
610T0039
|
|
Hospital Revenue Code
|
610
|
| 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 JOINT OF LWR EXTR W/DYE
|
Professional
|
Both
|
$4,137.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$2,482.20 |
| Rate for Payer: Aetna Commercial |
$771.72
|
| Rate for Payer: Ambetter Exchange |
$285.00
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$285.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$342.00
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$886.05
|
| Rate for Payer: Healthspan PPO |
$530.29
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$285.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,482.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$370.50
|
| Rate for Payer: UHCCP Medicaid |
$1,447.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$285.00
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
IP
|
$4,137.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,241.10 |
| Max. Negotiated Rate |
$3,971.52 |
| Rate for Payer: Aetna Commercial |
$3,185.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.86
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$3,433.71
|
| Rate for Payer: First Health Commercial |
$3,930.15
|
| Rate for Payer: Humana Commercial |
$3,516.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.53
|
| Rate for Payer: PHCS Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare All Payer |
$3,640.56
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
OP
|
$4,137.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
61000038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,971.52 |
| Rate for Payer: Aetna Commercial |
$3,185.49
|
| Rate for Payer: Anthem Medicaid |
$1,422.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$3,433.71
|
| Rate for Payer: First Health Commercial |
$3,930.15
|
| Rate for Payer: Humana Commercial |
$3,516.45
|
| Rate for Payer: Humana KY Medicaid |
$1,422.71
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.53
|
| Rate for Payer: PHCS Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare All Payer |
$3,640.56
|
|
|
MRI JOINT OF LWR EXTR W/DYE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
610P0038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$886.05 |
| Rate for Payer: Aetna Commercial |
$771.72
|
| Rate for Payer: Ambetter Exchange |
$285.00
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$285.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$342.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$886.05
|
| Rate for Payer: Healthspan PPO |
$530.29
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$285.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| 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 |
$370.50
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$285.00
|
|
|
MRI JOINT OF LWR EXTR W/DYE(T
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
610T0038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,181.10 |
| Max. Negotiated Rate |
$3,779.52 |
| Rate for Payer: Aetna Commercial |
$3,031.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.86
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cigna Commercial |
$3,267.71
|
| Rate for Payer: First Health Commercial |
$3,740.15
|
| Rate for Payer: Humana Commercial |
$3,346.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.53
|
| Rate for Payer: PHCS Commercial |
$3,779.52
|
| Rate for Payer: United Healthcare All Payer |
$3,464.56
|
|
|
MRI JOINT OF LWR EXTR W/DYE(T
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
610T0038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,779.52 |
| Rate for Payer: Aetna Commercial |
$3,031.49
|
| Rate for Payer: Anthem Medicaid |
$1,353.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cigna Commercial |
$3,267.71
|
| Rate for Payer: First Health Commercial |
$3,740.15
|
| Rate for Payer: Humana Commercial |
$3,346.45
|
| Rate for Payer: Humana KY Medicaid |
$1,353.93
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.53
|
| Rate for Payer: PHCS Commercial |
$3,779.52
|
| Rate for Payer: United Healthcare All Payer |
$3,464.56
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
OP
|
$4,222.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$4,053.12 |
| Rate for Payer: Aetna Commercial |
$3,250.94
|
| Rate for Payer: Anthem Medicaid |
$1,451.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$2,111.00
|
| Rate for Payer: Cash Price |
$2,111.00
|
| Rate for Payer: Cigna Commercial |
$3,504.26
|
| Rate for Payer: First Health Commercial |
$4,010.90
|
| Rate for Payer: Humana Commercial |
$3,588.70
|
| Rate for Payer: Humana KY Medicaid |
$1,451.95
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,466.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,115.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,715.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,673.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.18
|
| Rate for Payer: PHCS Commercial |
$4,053.12
|
| Rate for Payer: United Healthcare All Payer |
$3,715.36
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
610T0058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,779.52 |
| Rate for Payer: Aetna Commercial |
$3,031.49
|
| Rate for Payer: Anthem Medicaid |
$1,353.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cigna Commercial |
$3,267.71
|
| Rate for Payer: First Health Commercial |
$3,740.15
|
| Rate for Payer: Humana Commercial |
$3,346.45
|
| Rate for Payer: Humana KY Medicaid |
$1,353.93
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.53
|
| Rate for Payer: PHCS Commercial |
$3,779.52
|
| Rate for Payer: United Healthcare All Payer |
$3,464.56
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Professional
|
Both
|
$4,222.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$103.51 |
| Max. Negotiated Rate |
$2,533.20 |
| Rate for Payer: Aetna Commercial |
$771.35
|
| Rate for Payer: Ambetter Exchange |
$283.53
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$283.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.24
|
| Rate for Payer: Cash Price |
$2,111.00
|
| Rate for Payer: Cash Price |
$2,111.00
|
| Rate for Payer: Cigna Commercial |
$882.75
|
| Rate for Payer: Healthspan PPO |
$530.03
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$283.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,533.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$368.59
|
| Rate for Payer: UHCCP Medicaid |
$1,477.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.53
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
IP
|
$4,222.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,266.60 |
| Max. Negotiated Rate |
$4,053.12 |
| Rate for Payer: Aetna Commercial |
$3,250.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.16
|
| Rate for Payer: Cash Price |
$2,111.00
|
| Rate for Payer: Cigna Commercial |
$3,504.26
|
| Rate for Payer: First Health Commercial |
$4,010.90
|
| Rate for Payer: Humana Commercial |
$3,588.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,115.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,715.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,673.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.18
|
| Rate for Payer: PHCS Commercial |
$4,053.12
|
| Rate for Payer: United Healthcare All Payer |
$3,715.36
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
610P0058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$882.75 |
| Rate for Payer: Aetna Commercial |
$771.35
|
| Rate for Payer: Ambetter Exchange |
$283.53
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$283.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.24
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$882.75
|
| Rate for Payer: Healthspan PPO |
$530.03
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$283.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$368.59
|
| Rate for Payer: UHCCP Medicaid |
$99.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.53
|
|
|
MRI JOINT UPPER EXT W/CONT
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
610T0058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,181.10 |
| Max. Negotiated Rate |
$3,779.52 |
| Rate for Payer: Aetna Commercial |
$3,031.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.86
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cigna Commercial |
$3,267.71
|
| Rate for Payer: First Health Commercial |
$3,740.15
|
| Rate for Payer: Humana Commercial |
$3,346.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.53
|
| Rate for Payer: PHCS Commercial |
$3,779.52
|
| Rate for Payer: United Healthcare All Payer |
$3,464.56
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Professional
|
Both
|
$3,852.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.62 |
| Max. Negotiated Rate |
$2,311.20 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Ambetter Exchange |
$186.94
|
| Rate for Payer: Anthem Medicaid |
$338.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.33
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$757.55
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$338.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.41
|
| Rate for Payer: Molina Healthcare Passport |
$338.64
|
| Rate for Payer: Multiplan PHCS |
$2,311.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.02
|
| Rate for Payer: UHCCP Medicaid |
$1,348.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.94
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
IP
|
$3,852.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,155.60 |
| Max. Negotiated Rate |
$3,697.92 |
| Rate for Payer: Aetna Commercial |
$2,966.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.56
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$3,197.16
|
| Rate for Payer: First Health Commercial |
$3,659.40
|
| Rate for Payer: Humana Commercial |
$3,274.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,842.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,389.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,657.88
|
| Rate for Payer: PHCS Commercial |
$3,697.92
|
| Rate for Payer: United Healthcare All Payer |
$3,389.76
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
OP
|
$3,852.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
61000030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,697.92 |
| Rate for Payer: Aetna Commercial |
$2,966.04
|
| Rate for Payer: Anthem Medicaid |
$1,324.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$3,197.16
|
| Rate for Payer: First Health Commercial |
$3,659.40
|
| Rate for Payer: Humana Commercial |
$3,274.20
|
| Rate for Payer: Humana KY Medicaid |
$1,324.70
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,338.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,842.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,351.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,389.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,657.88
|
| Rate for Payer: PHCS Commercial |
$3,697.92
|
| Rate for Payer: United Healthcare All Payer |
$3,389.76
|
|
|
MRI JOINT UPR EXTREM W/O DY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
610P0030
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$757.55 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Ambetter Exchange |
$186.94
|
| Rate for Payer: Anthem Medicaid |
$338.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.33
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$757.55
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$338.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.41
|
| Rate for Payer: Molina Healthcare Passport |
$338.64
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.02
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$342.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.94
|
|
|
MRI JOINT UPR EXTREM W/O DY(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
610T0030
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
