|
MRI JOINT UPR EXTREM W/O DY(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
610T0030
|
|
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 JOINT UPR EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,365.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,309.50 |
| Max. Negotiated Rate |
$4,190.40 |
| Rate for Payer: Aetna Commercial |
$3,361.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,404.70
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$3,622.95
|
| Rate for Payer: First Health Commercial |
$4,146.75
|
| Rate for Payer: Humana Commercial |
$3,710.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,841.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,797.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,011.85
|
| Rate for Payer: PHCS Commercial |
$4,190.40
|
| Rate for Payer: United Healthcare All Payer |
$3,841.20
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Professional
|
Both
|
$4,365.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$2,619.00 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$351.55
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.86
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$1,456.47
|
| 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 |
$351.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$2,619.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$457.01
|
| Rate for Payer: UHCCP Medicaid |
$1,527.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.55
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,365.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
61000032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,190.40 |
| Rate for Payer: Aetna Commercial |
$3,361.05
|
| Rate for Payer: Anthem Medicaid |
$1,501.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,404.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cash Price |
$2,182.50
|
| Rate for Payer: Cigna Commercial |
$3,622.95
|
| Rate for Payer: First Health Commercial |
$4,146.75
|
| Rate for Payer: Humana Commercial |
$3,710.25
|
| Rate for Payer: Humana KY Medicaid |
$1,501.12
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,516.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,531.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,841.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,797.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,011.85
|
| Rate for Payer: PHCS Commercial |
$4,190.40
|
| Rate for Payer: United Healthcare All Payer |
$3,841.20
|
|
|
MRI JOINT UPR EXTR W/O&W/DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
610P0032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,456.47 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$351.55
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.86
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$1,456.47
|
| 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 |
$351.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$457.01
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.55
|
|
|
MRI JOINT UPR EXTR W/O&W/DY(T
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
610T0032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI JOINT UPR EXTR W/O&W/DY(T
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
610T0032
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem Medicaid |
$1,415.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Humana KY Medicaid |
$1,415.15
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI LOWER EXTREMITY W/DYE
|
Facility
|
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,184.10 |
| Max. Negotiated Rate |
$3,789.12 |
| Rate for Payer: Aetna Commercial |
$3,039.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.66
|
| Rate for Payer: Cash Price |
$1,973.50
|
| Rate for Payer: Cigna Commercial |
$3,276.01
|
| Rate for Payer: First Health Commercial |
$3,749.65
|
| Rate for Payer: Humana Commercial |
$3,354.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,473.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,960.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,433.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.43
|
| Rate for Payer: PHCS Commercial |
$3,789.12
|
| Rate for Payer: United Healthcare All Payer |
$3,473.36
|
|
|
MRI LOWER EXTREMITY W/DYE
|
Facility
|
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,789.12 |
| Rate for Payer: Aetna Commercial |
$3,039.19
|
| Rate for Payer: Anthem Medicaid |
$1,357.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,078.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,973.50
|
| Rate for Payer: Cash Price |
$1,973.50
|
| Rate for Payer: Cigna Commercial |
$3,276.01
|
| Rate for Payer: First Health Commercial |
$3,749.65
|
| Rate for Payer: Humana Commercial |
$3,354.95
|
| Rate for Payer: Humana KY Medicaid |
$1,357.37
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,371.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,236.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,384.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,473.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,960.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,157.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,433.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.43
|
| Rate for Payer: PHCS Commercial |
$3,789.12
|
| Rate for Payer: United Healthcare All Payer |
$3,473.36
|
|
|
MRI LOWER EXTREMITY W/DYE
|
Professional
|
Both
|
$3,947.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
61000035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$2,368.20 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Ambetter Exchange |
$240.50
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$240.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.60
|
| Rate for Payer: Cash Price |
$1,973.50
|
| Rate for Payer: Cash Price |
$1,973.50
|
| Rate for Payer: Cigna Commercial |
$895.43
|
| Rate for Payer: Healthspan PPO |
$529.79
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,368.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.65
|
| Rate for Payer: UHCCP Medicaid |
$1,381.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.50
|
|
|
MRI LOWER EXTREMITY W/DYE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
610P0035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$895.43 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Ambetter Exchange |
$240.50
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$240.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.60
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$895.43
|
| Rate for Payer: Healthspan PPO |
$529.79
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.65
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$240.50
|
|
|
MRI LOWER EXTREMITY W/DYE(T
|
Facility
|
OP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
610T0035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem Medicaid |
$1,271.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Humana KY Medicaid |
$1,271.40
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,296.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,550.93
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI LOWER EXTREMITY W/DYE(T
|
Facility
|
IP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
610T0035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,109.10 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,550.93
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI LOWER EXTREMITY W/O DYE
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$2,296.20 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Ambetter Exchange |
$203.70
|
| Rate for Payer: Anthem Medicaid |
$338.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$203.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$203.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$244.44
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cigna Commercial |
$766.37
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$338.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$203.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.00
|
| Rate for Payer: Molina Healthcare Passport |
$338.24
|
| Rate for Payer: Multiplan PHCS |
$2,296.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$264.81
|
| Rate for Payer: UHCCP Medicaid |
$1,339.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$341.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$203.70
|
|
|
MRI LOWER EXTREMITY W/O DYE
|
Facility
|
IP
|
$3,827.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.10 |
| Max. Negotiated Rate |
$3,673.92 |
| Rate for Payer: Aetna Commercial |
$2,946.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,985.06
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cigna Commercial |
$3,176.41
|
| Rate for Payer: First Health Commercial |
$3,635.65
|
| Rate for Payer: Humana Commercial |
$3,252.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,138.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,824.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,148.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,367.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,870.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,329.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.63
|
| Rate for Payer: PHCS Commercial |
$3,673.92
|
| Rate for Payer: United Healthcare All Payer |
$3,367.76
|
|
|
MRI LOWER EXTREMITY W/O DYE
|
Facility
|
OP
|
$3,827.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
61000034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,673.92 |
| Rate for Payer: Aetna Commercial |
$2,946.79
|
| Rate for Payer: Anthem Medicaid |
$1,316.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,985.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cigna Commercial |
$3,176.41
|
| Rate for Payer: First Health Commercial |
$3,635.65
|
| Rate for Payer: Humana Commercial |
$3,252.95
|
| Rate for Payer: Humana KY Medicaid |
$1,316.11
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,329.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,138.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,824.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,342.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,367.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,870.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,329.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.63
|
| Rate for Payer: PHCS Commercial |
$3,673.92
|
| Rate for Payer: United Healthcare All Payer |
$3,367.76
|
|
|
MRI LOWER EXTREMITY W/O DYE(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
610P0034
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$766.37 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Ambetter Exchange |
$203.70
|
| Rate for Payer: Anthem Medicaid |
$338.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$203.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$203.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$244.44
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$766.37
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$338.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$203.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$203.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$345.00
|
| Rate for Payer: Molina Healthcare Passport |
$338.24
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$264.81
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$341.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$203.70
|
|
|
MRI LOWER EXTREMITY W/O DYE(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
610T0034
|
|
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 LOWER EXTREMITY W/O DYE(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
610T0034
|
|
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 LUMBAR SPINE W/CONTRAST
|
Professional
|
Both
|
$4,104.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
61000019
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Ambetter Exchange |
$248.16
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$248.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$248.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$297.79
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cash Price |
$2,052.00
|
| Rate for Payer: Cigna Commercial |
$923.35
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$248.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| Rate for Payer: Multiplan PHCS |
$2,462.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.61
|
| Rate for Payer: UHCCP Medicaid |
$1,436.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$248.16
|
|
|
MRI LUMBAR SPINE W/CONTRAST
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
61000019
|
|
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 LUMBAR SPINE W/CONTRAST
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
61000019
|
|
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 LUMBAR SPINE W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
610P0019
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$923.35 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Ambetter Exchange |
$248.16
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$248.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$248.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$297.79
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$923.35
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$248.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.61
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$248.16
|
|
|
MRI LUMBAR SPINE W/CONTRAST(T
|
Facility
|
OP
|
$3,804.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
610T0019
|
|
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 LUMBAR SPINE W/CONTRAST(T
|
Facility
|
IP
|
$3,804.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
610T0019
|
|
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
|
|
