|
MRI LUMBAR SPINE W/O CONTRAS(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
610P0018
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$816.86 |
| Rate for Payer: Aetna Commercial |
$644.44
|
| Rate for Payer: Ambetter Exchange |
$176.12
|
| Rate for Payer: Anthem Medicaid |
$399.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$176.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$176.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$211.34
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$816.86
|
| Rate for Payer: Healthspan PPO |
$442.83
|
| Rate for Payer: Humana Medicaid |
$399.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$176.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.64
|
| Rate for Payer: Molina Healthcare Passport |
$399.65
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.96
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$176.12
|
|
|
MRI LUMBAR SPINE W/O CONTRAS(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
610T0018
|
|
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 LUMBAR SPINE W/O CONTRAS(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
610T0018
|
|
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 LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
61000018
|
|
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 LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
61000018
|
|
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 LUMBAR SPINE W/O CONTRAST
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$644.44
|
| Rate for Payer: Ambetter Exchange |
$176.12
|
| Rate for Payer: Anthem Medicaid |
$399.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$176.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$176.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$211.34
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$816.86
|
| Rate for Payer: Healthspan PPO |
$442.83
|
| Rate for Payer: Humana Medicaid |
$399.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$176.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.64
|
| Rate for Payer: Molina Healthcare Passport |
$399.65
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.96
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$176.12
|
|
|
MRI LUMBAR SPINE W WO CONTRA
|
Facility
|
IP
|
$4,609.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,382.70 |
| Max. Negotiated Rate |
$4,424.64 |
| Rate for Payer: Aetna Commercial |
$3,548.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,595.02
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cigna Commercial |
$3,825.47
|
| Rate for Payer: First Health Commercial |
$4,378.55
|
| Rate for Payer: Humana Commercial |
$3,917.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,779.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,401.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,055.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,009.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,180.21
|
| Rate for Payer: PHCS Commercial |
$4,424.64
|
| Rate for Payer: United Healthcare All Payer |
$4,055.92
|
|
|
MRI LUMBAR SPINE W WO CONTRA
|
Professional
|
Both
|
$4,609.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$151.28 |
| Max. Negotiated Rate |
$2,765.40 |
| Rate for Payer: Aetna Commercial |
$1,006.26
|
| Rate for Payer: Ambetter Exchange |
$293.65
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.38
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cigna Commercial |
$1,498.19
|
| Rate for Payer: Healthspan PPO |
$691.45
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$151.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$2,765.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.75
|
| Rate for Payer: UHCCP Medicaid |
$1,613.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.65
|
|
|
MRI LUMBAR SPINE W WO CONTRA
|
Facility
|
OP
|
$4,609.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
61000022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,424.64 |
| Rate for Payer: Aetna Commercial |
$3,548.93
|
| Rate for Payer: Anthem Medicaid |
$1,585.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,595.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cigna Commercial |
$3,825.47
|
| Rate for Payer: First Health Commercial |
$4,378.55
|
| Rate for Payer: Humana Commercial |
$3,917.65
|
| Rate for Payer: Humana KY Medicaid |
$1,585.04
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,601.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,779.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,401.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,616.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,055.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,009.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,180.21
|
| Rate for Payer: PHCS Commercial |
$4,424.64
|
| Rate for Payer: United Healthcare All Payer |
$4,055.92
|
|
|
MRI LUMBAR SPINE W WO CONTRA(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
610P0022
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$1,498.19 |
| Rate for Payer: Aetna Commercial |
$1,006.26
|
| Rate for Payer: Ambetter Exchange |
$293.65
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.38
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$1,498.19
|
| Rate for Payer: Healthspan PPO |
$691.45
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$151.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.75
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.65
|
|
|
MRI LUMBAR SPINE W WO CONTRA(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
610T0022
|
|
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 LUMBAR SPINE W WO CONTRA(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
610T0022
|
|
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 LWR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$4,534.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,352.64 |
| Rate for Payer: Aetna Commercial |
$3,491.18
|
| Rate for Payer: Anthem Medicaid |
$1,559.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,536.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cigna Commercial |
$3,763.22
|
| Rate for Payer: First Health Commercial |
$4,307.30
|
| Rate for Payer: Humana Commercial |
$3,853.90
|
| Rate for Payer: Humana KY Medicaid |
$1,559.24
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,575.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,346.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,590.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,944.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,128.46
|
| Rate for Payer: PHCS Commercial |
$4,352.64
|
| Rate for Payer: United Healthcare All Payer |
$3,989.92
|
|
|
MRI LWR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$4,534.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,360.20 |
| Max. Negotiated Rate |
$4,352.64 |
| Rate for Payer: Aetna Commercial |
$3,491.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,536.52
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cigna Commercial |
$3,763.22
|
| Rate for Payer: First Health Commercial |
$4,307.30
|
| Rate for Payer: Humana Commercial |
$3,853.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,346.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,360.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,944.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,128.46
|
| Rate for Payer: PHCS Commercial |
$4,352.64
|
| Rate for Payer: United Healthcare All Payer |
$3,989.92
|
|
|
MRI LWR EXTREMITY W/O&W/DYE
|
Professional
|
Both
|
$4,534.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
61000036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$2,720.40 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$308.82
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$308.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$308.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$370.58
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cigna Commercial |
$1,474.11
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$308.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,720.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$401.47
|
| Rate for Payer: UHCCP Medicaid |
$1,586.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$308.82
|
|
|
MRI LWR EXTREMITY W/O&W/DYE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
610P0036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$1,474.11 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$308.82
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$308.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$308.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$370.58
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$1,474.11
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$308.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$401.47
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$308.82
|
|
|
MRI LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
610T0036
|
|
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 LWR EXTREMITY W/O&W/DYE(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
610T0036
|
|
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 NEEDLE PLACE BREAST
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$807.00 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,071.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,098.20
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna Commercial |
$2,232.70
|
| Rate for Payer: First Health Commercial |
$2,555.50
|
| Rate for Payer: Humana Commercial |
$2,286.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,205.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,985.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,367.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,017.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,856.10
|
| Rate for Payer: PHCS Commercial |
$2,582.40
|
| Rate for Payer: United Healthcare All Payer |
$2,367.20
|
|
|
MRI NEEDLE PLACE BREAST
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$807.00 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,071.30
|
| Rate for Payer: Anthem Medicaid |
$925.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,098.20
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna Commercial |
$2,232.70
|
| Rate for Payer: First Health Commercial |
$2,555.50
|
| Rate for Payer: Humana Commercial |
$2,286.50
|
| Rate for Payer: Humana KY Medicaid |
$925.09
|
| Rate for Payer: Kentucky WC Medicaid |
$934.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,205.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,985.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$807.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$943.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,367.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,017.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,856.10
|
| Rate for Payer: PHCS Commercial |
$2,582.40
|
| Rate for Payer: United Healthcare All Payer |
$2,367.20
|
|
|
MRI NEEDLE PLACE BREAST
|
Professional
|
Both
|
$2,690.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$97.27 |
| Max. Negotiated Rate |
$1,614.00 |
| Rate for Payer: Aetna Commercial |
$682.33
|
| Rate for Payer: Ambetter Exchange |
$372.10
|
| Rate for Payer: Anthem Medicaid |
$340.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$372.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$446.52
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna Commercial |
$726.96
|
| Rate for Payer: Healthspan PPO |
$639.36
|
| Rate for Payer: Humana Medicaid |
$340.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$372.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$347.37
|
| Rate for Payer: Molina Healthcare Passport |
$340.56
|
| Rate for Payer: Multiplan PHCS |
$1,614.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.73
|
| Rate for Payer: UHCCP Medicaid |
$941.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$372.10
|
|
|
MRI NEEDLE PLACE BREAST(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
610P0048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$726.96 |
| Rate for Payer: Aetna Commercial |
$682.33
|
| Rate for Payer: Ambetter Exchange |
$372.10
|
| Rate for Payer: Anthem Medicaid |
$340.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$372.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$446.52
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$726.96
|
| Rate for Payer: Healthspan PPO |
$639.36
|
| Rate for Payer: Humana Medicaid |
$340.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$372.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$347.37
|
| Rate for Payer: Molina Healthcare Passport |
$340.56
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.73
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$372.10
|
|
|
MRI NEEDLE PLACE BREAST(T
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
610T0048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.35
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
MRI NEEDLE PLACE BREAST(T
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
HCPCS 77021
|
| Hospital Charge Code |
610T0048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$754.50 |
| Max. Negotiated Rate |
$2,414.40 |
| Rate for Payer: Aetna Commercial |
$1,936.55
|
| Rate for Payer: Anthem Medicaid |
$864.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,961.70
|
| Rate for Payer: Cash Price |
$1,257.50
|
| Rate for Payer: Cigna Commercial |
$2,087.45
|
| Rate for Payer: First Health Commercial |
$2,389.25
|
| Rate for Payer: Humana Commercial |
$2,137.75
|
| Rate for Payer: Humana KY Medicaid |
$864.91
|
| Rate for Payer: Kentucky WC Medicaid |
$873.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,062.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,213.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,886.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.35
|
| Rate for Payer: PHCS Commercial |
$2,414.40
|
| Rate for Payer: United Healthcare All Payer |
$2,213.20
|
|
|
MRI PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Humana KY Medicaid |
$1,281.03
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,306.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
