|
MRI PELVIS W/CONTRAST
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,117.50 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| 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: 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 |
$1,117.50
|
| 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
|
|
|
MRI PELVIS W/CONTRAST
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$2,235.00 |
| Rate for Payer: Aetna Commercial |
$781.28
|
| Rate for Payer: Ambetter Exchange |
$246.17
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$246.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$246.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$295.40
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$908.04
|
| Rate for Payer: Healthspan PPO |
$536.86
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$246.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$2,235.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$320.02
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$246.17
|
|
|
MRI PELVIS W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
610P0055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$908.04 |
| Rate for Payer: Aetna Commercial |
$781.28
|
| Rate for Payer: Ambetter Exchange |
$246.17
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$246.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$246.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$295.40
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$908.04
|
| Rate for Payer: Healthspan PPO |
$536.86
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$246.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$320.02
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$246.17
|
|
|
MRI PELVIS W/CONTRAST(T
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
610T0055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
MRI PELVIS W/CONTRAST(T
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
610T0055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
MRI PELVIS WO CONTRAST
|
Facility
|
IP
|
$3,827.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
61000024
|
|
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 PELVIS WO CONTRAST
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
61000024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$2,296.20 |
| Rate for Payer: Aetna Commercial |
$639.05
|
| Rate for Payer: Ambetter Exchange |
$209.06
|
| Rate for Payer: Anthem Medicaid |
$357.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.87
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cigna Commercial |
$778.44
|
| Rate for Payer: Healthspan PPO |
$439.12
|
| Rate for Payer: Humana Medicaid |
$357.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.78
|
| Rate for Payer: Molina Healthcare Passport |
$357.63
|
| Rate for Payer: Multiplan PHCS |
$2,296.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.78
|
| Rate for Payer: UHCCP Medicaid |
$1,339.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.06
|
|
|
MRI PELVIS WO CONTRAST
|
Facility
|
OP
|
$3,827.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
61000024
|
|
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 PELVIS WO CONTRAST(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
610P0024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$778.44 |
| Rate for Payer: Aetna Commercial |
$639.05
|
| Rate for Payer: Ambetter Exchange |
$209.06
|
| Rate for Payer: Anthem Medicaid |
$357.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.87
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$778.44
|
| Rate for Payer: Healthspan PPO |
$439.12
|
| Rate for Payer: Humana Medicaid |
$357.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.78
|
| Rate for Payer: Molina Healthcare Passport |
$357.63
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.78
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.06
|
|
|
MRI PELVIS WO CONTRAST(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
610T0024
|
|
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 PELVIS WO CONTRAST(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
610T0024
|
|
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 PELVIS W/WO CONTRAST
|
Facility
|
OP
|
$4,509.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,328.64 |
| Rate for Payer: Aetna Commercial |
$3,471.93
|
| Rate for Payer: Anthem Medicaid |
$1,550.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna Commercial |
$3,742.47
|
| Rate for Payer: First Health Commercial |
$4,283.55
|
| Rate for Payer: Humana Commercial |
$3,832.65
|
| Rate for Payer: Humana KY Medicaid |
$1,550.65
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,566.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,697.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,327.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,581.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,967.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,607.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,922.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,111.21
|
| Rate for Payer: PHCS Commercial |
$4,328.64
|
| Rate for Payer: United Healthcare All Payer |
$3,967.92
|
|
|
MRI PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$4,509.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,352.70 |
| Max. Negotiated Rate |
$4,328.64 |
| Rate for Payer: Aetna Commercial |
$3,471.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.02
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna Commercial |
$3,742.47
|
| Rate for Payer: First Health Commercial |
$4,283.55
|
| Rate for Payer: Humana Commercial |
$3,832.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,697.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,327.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,967.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,607.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,922.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,111.21
|
| Rate for Payer: PHCS Commercial |
$4,328.64
|
| Rate for Payer: United Healthcare All Payer |
$3,967.92
|
|
|
MRI PELVIS W/WO CONTRAST
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
61000025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$143.16 |
| Max. Negotiated Rate |
$2,705.40 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Ambetter Exchange |
$308.67
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$308.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$308.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$370.40
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna Commercial |
$1,485.09
|
| Rate for Payer: Healthspan PPO |
$682.63
|
| Rate for Payer: Humana Medicaid |
$723.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$308.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.96
|
| Rate for Payer: Molina Healthcare Passport |
$723.49
|
| Rate for Payer: Multiplan PHCS |
$2,705.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$401.27
|
| Rate for Payer: UHCCP Medicaid |
$1,578.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$308.67
|
|
|
MRI PELVIS W/WO CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
610P0025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,485.09 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Ambetter Exchange |
$308.67
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$308.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$308.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$370.40
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$1,485.09
|
| Rate for Payer: Healthspan PPO |
$682.63
|
| Rate for Payer: Humana Medicaid |
$723.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$308.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.96
|
| Rate for Payer: Molina Healthcare Passport |
$723.49
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$401.27
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$308.67
|
|
|
MRI PELVIS W/WO CONTRAST(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
610T0025
|
|
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 PELVIS W/WO CONTRAST(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
610T0025
|
|
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 QUAD COBAL CRTD DTPA2Q1
|
Facility
|
OP
|
$75,543.12
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,662.94 |
| Max. Negotiated Rate |
$72,521.40 |
| Rate for Payer: Aetna Commercial |
$58,168.20
|
| Rate for Payer: Anthem Medicaid |
$25,979.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,923.63
|
| Rate for Payer: Cash Price |
$37,771.56
|
| Rate for Payer: Cigna Commercial |
$62,700.79
|
| Rate for Payer: First Health Commercial |
$71,765.96
|
| Rate for Payer: Humana Commercial |
$64,211.65
|
| Rate for Payer: Humana KY Medicaid |
$25,979.28
|
| Rate for Payer: Kentucky WC Medicaid |
$26,243.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,945.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,750.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,662.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,500.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,477.95
|
| Rate for Payer: Ohio Health Group HMO |
$56,657.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,722.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,124.75
|
| Rate for Payer: PHCS Commercial |
$72,521.40
|
| Rate for Payer: United Healthcare All Payer |
$66,477.95
|
|
|
MRI QUAD COBAL CRTD DTPA2Q1
|
Facility
|
IP
|
$75,543.12
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,662.94 |
| Max. Negotiated Rate |
$72,521.40 |
| Rate for Payer: Aetna Commercial |
$58,168.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,923.63
|
| Rate for Payer: Cash Price |
$37,771.56
|
| Rate for Payer: Cigna Commercial |
$62,700.79
|
| Rate for Payer: First Health Commercial |
$71,765.96
|
| Rate for Payer: Humana Commercial |
$64,211.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,945.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,750.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,662.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,477.95
|
| Rate for Payer: Ohio Health Group HMO |
$56,657.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,722.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,124.75
|
| Rate for Payer: PHCS Commercial |
$72,521.40
|
| Rate for Payer: United Healthcare All Payer |
$66,477.95
|
|
|
MRI SURESCAN CRT-D DTPB2QQ
|
Facility
|
OP
|
$75,543.12
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,662.94 |
| Max. Negotiated Rate |
$72,521.40 |
| Rate for Payer: Aetna Commercial |
$58,168.20
|
| Rate for Payer: Anthem Medicaid |
$25,979.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,923.63
|
| Rate for Payer: Cash Price |
$37,771.56
|
| Rate for Payer: Cigna Commercial |
$62,700.79
|
| Rate for Payer: First Health Commercial |
$71,765.96
|
| Rate for Payer: Humana Commercial |
$64,211.65
|
| Rate for Payer: Humana KY Medicaid |
$25,979.28
|
| Rate for Payer: Kentucky WC Medicaid |
$26,243.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,945.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,750.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,662.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,500.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,477.95
|
| Rate for Payer: Ohio Health Group HMO |
$56,657.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,722.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,124.75
|
| Rate for Payer: PHCS Commercial |
$72,521.40
|
| Rate for Payer: United Healthcare All Payer |
$66,477.95
|
|
|
MRI SURESCAN CRT-D DTPB2QQ
|
Facility
|
IP
|
$75,543.12
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,662.94 |
| Max. Negotiated Rate |
$72,521.40 |
| Rate for Payer: Aetna Commercial |
$58,168.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,923.63
|
| Rate for Payer: Cash Price |
$37,771.56
|
| Rate for Payer: Cigna Commercial |
$62,700.79
|
| Rate for Payer: First Health Commercial |
$71,765.96
|
| Rate for Payer: Humana Commercial |
$64,211.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,945.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,750.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,662.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,477.95
|
| Rate for Payer: Ohio Health Group HMO |
$56,657.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,722.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,124.75
|
| Rate for Payer: PHCS Commercial |
$72,521.40
|
| Rate for Payer: United Healthcare All Payer |
$66,477.95
|
|
|
MRI SURESCAN CRT-P BATTERY
|
Facility
|
IP
|
$21,049.14
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,314.74 |
| Max. Negotiated Rate |
$20,207.17 |
| Rate for Payer: Aetna Commercial |
$16,207.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,418.33
|
| Rate for Payer: Cash Price |
$10,524.57
|
| Rate for Payer: Cigna Commercial |
$17,470.79
|
| Rate for Payer: First Health Commercial |
$19,996.68
|
| Rate for Payer: Humana Commercial |
$17,891.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,260.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,534.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,314.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,523.24
|
| Rate for Payer: Ohio Health Group HMO |
$15,786.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,839.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,312.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,523.91
|
| Rate for Payer: PHCS Commercial |
$20,207.17
|
| Rate for Payer: United Healthcare All Payer |
$18,523.24
|
|
|
MRI SURESCAN CRT-P BATTERY
|
Facility
|
OP
|
$21,049.14
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,314.74 |
| Max. Negotiated Rate |
$20,207.17 |
| Rate for Payer: Aetna Commercial |
$16,207.84
|
| Rate for Payer: Anthem Medicaid |
$7,238.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,418.33
|
| Rate for Payer: Cash Price |
$10,524.57
|
| Rate for Payer: Cigna Commercial |
$17,470.79
|
| Rate for Payer: First Health Commercial |
$19,996.68
|
| Rate for Payer: Humana Commercial |
$17,891.77
|
| Rate for Payer: Humana KY Medicaid |
$7,238.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,312.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,260.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,534.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,314.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,384.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,523.24
|
| Rate for Payer: Ohio Health Group HMO |
$15,786.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,839.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,312.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,523.91
|
| Rate for Payer: PHCS Commercial |
$20,207.17
|
| Rate for Payer: United Healthcare All Payer |
$18,523.24
|
|
|
MRI TEMPOROMANDIBULAR JOINT
|
Facility
|
IP
|
$3,778.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,133.40 |
| Max. Negotiated Rate |
$3,626.88 |
| Rate for Payer: Aetna Commercial |
$2,909.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.84
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cigna Commercial |
$3,135.74
|
| Rate for Payer: First Health Commercial |
$3,589.10
|
| Rate for Payer: Humana Commercial |
$3,211.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,788.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.82
|
| Rate for Payer: PHCS Commercial |
$3,626.88
|
| Rate for Payer: United Healthcare All Payer |
$3,324.64
|
|
|
MRI TEMPOROMANDIBULAR JOINT
|
Facility
|
OP
|
$3,778.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,626.88 |
| Rate for Payer: Aetna Commercial |
$2,909.06
|
| Rate for Payer: Anthem Medicaid |
$1,299.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cigna Commercial |
$3,135.74
|
| Rate for Payer: First Health Commercial |
$3,589.10
|
| Rate for Payer: Humana Commercial |
$3,211.30
|
| Rate for Payer: Humana KY Medicaid |
$1,299.25
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,788.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,325.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.82
|
| Rate for Payer: PHCS Commercial |
$3,626.88
|
| Rate for Payer: United Healthcare All Payer |
$3,324.64
|
|
