|
MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
Both
|
$3,778.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
61000001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.44 |
| Max. Negotiated Rate |
$2,266.80 |
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Ambetter Exchange |
$239.51
|
| Rate for Payer: Anthem Medicaid |
$343.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$239.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$239.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$287.41
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cigna Commercial |
$759.44
|
| Rate for Payer: Healthspan PPO |
$442.58
|
| Rate for Payer: Humana Medicaid |
$343.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$239.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.47
|
| Rate for Payer: Molina Healthcare Passport |
$343.60
|
| Rate for Payer: Multiplan PHCS |
$2,266.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$311.36
|
| Rate for Payer: UHCCP Medicaid |
$1,322.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$239.51
|
|
|
MRI TEMPOROMANDIBULAR JOINT(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
610P0001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$759.44 |
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Ambetter Exchange |
$239.51
|
| Rate for Payer: Anthem Medicaid |
$343.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$239.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$239.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$287.41
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$759.44
|
| Rate for Payer: Healthspan PPO |
$442.58
|
| Rate for Payer: Humana Medicaid |
$343.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$239.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.47
|
| Rate for Payer: Molina Healthcare Passport |
$343.60
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$311.36
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$239.51
|
|
|
MRI TEMPOROMANDIBULAR JOINT(T
|
Facility
|
IP
|
$3,528.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
610T0001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,058.40 |
| Max. Negotiated Rate |
$3,386.88 |
| Rate for Payer: Aetna Commercial |
$2,716.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,751.84
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$2,928.24
|
| Rate for Payer: First Health Commercial |
$3,351.60
|
| Rate for Payer: Humana Commercial |
$2,998.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,603.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,104.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,822.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,069.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,434.32
|
| Rate for Payer: PHCS Commercial |
$3,386.88
|
| Rate for Payer: United Healthcare All Payer |
$3,104.64
|
|
|
MRI TEMPOROMANDIBULAR JOINT(T
|
Facility
|
OP
|
$3,528.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
610T0001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,386.88 |
| Rate for Payer: Aetna Commercial |
$2,716.56
|
| Rate for Payer: Anthem Medicaid |
$1,213.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,751.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$2,928.24
|
| Rate for Payer: First Health Commercial |
$3,351.60
|
| Rate for Payer: Humana Commercial |
$2,998.80
|
| Rate for Payer: Humana KY Medicaid |
$1,213.28
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,225.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,603.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,237.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,104.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,822.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,069.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,434.32
|
| Rate for Payer: PHCS Commercial |
$3,386.88
|
| Rate for Payer: United Healthcare All Payer |
$3,104.64
|
|
|
MRI THORACIC SPINE W AND WO
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$4,400.64 |
| Rate for Payer: Aetna Commercial |
$3,529.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,575.52
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,804.72
|
| Rate for Payer: First Health Commercial |
$4,354.80
|
| Rate for Payer: Humana Commercial |
$3,896.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,758.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,033.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,667.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,988.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.96
|
| Rate for Payer: PHCS Commercial |
$4,400.64
|
| Rate for Payer: United Healthcare All Payer |
$4,033.92
|
|
|
MRI THORACIC SPINE W AND WO
|
Professional
|
Both
|
$4,584.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$164.14 |
| Max. Negotiated Rate |
$2,750.40 |
| Rate for Payer: Aetna Commercial |
$1,024.97
|
| Rate for Payer: Ambetter Exchange |
$294.83
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$353.80
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$1,491.76
|
| Rate for Payer: Healthspan PPO |
$704.31
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$2,750.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$383.28
|
| Rate for Payer: UHCCP Medicaid |
$1,604.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.83
|
|
|
MRI THORACIC SPINE W AND WO
|
Facility
|
OP
|
$4,584.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
61000021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,400.64 |
| Rate for Payer: Aetna Commercial |
$3,529.68
|
| Rate for Payer: Anthem Medicaid |
$1,576.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,575.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cash Price |
$2,292.00
|
| Rate for Payer: Cigna Commercial |
$3,804.72
|
| Rate for Payer: First Health Commercial |
$4,354.80
|
| Rate for Payer: Humana Commercial |
$3,896.40
|
| Rate for Payer: Humana KY Medicaid |
$1,576.44
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,592.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,758.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,608.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,033.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,667.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,988.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.96
|
| Rate for Payer: PHCS Commercial |
$4,400.64
|
| Rate for Payer: United Healthcare All Payer |
$4,033.92
|
|
|
MRI THORACIC SPINE W AND WO(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
610P0021
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$1,491.76 |
| Rate for Payer: Aetna Commercial |
$1,024.97
|
| Rate for Payer: Ambetter Exchange |
$294.83
|
| Rate for Payer: Anthem Medicaid |
$782.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$353.80
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$1,491.76
|
| Rate for Payer: Healthspan PPO |
$704.31
|
| Rate for Payer: Humana Medicaid |
$782.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.47
|
| Rate for Payer: Molina Healthcare Passport |
$782.81
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$383.28
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.83
|
|
|
MRI THORACIC SPINE W AND WO(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
610T0021
|
|
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 THORACIC SPINE W AND WO(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
610T0021
|
|
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 THORACIC SPINE W/CONTRAS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
610P0017
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$905.67 |
| Rate for Payer: Aetna Commercial |
$800.22
|
| Rate for Payer: Ambetter Exchange |
$249.85
|
| Rate for Payer: Anthem Medicaid |
$445.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$249.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$249.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.82
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$905.67
|
| Rate for Payer: Healthspan PPO |
$549.87
|
| Rate for Payer: Humana Medicaid |
$445.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$249.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
| Rate for Payer: Molina Healthcare Passport |
$445.83
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$324.81
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$249.85
|
|
|
MRI THORACIC SPINE W/CONTRAS(T
|
Facility
|
IP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
610T0017
|
|
Hospital Revenue Code
|
612
|
| 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 THORACIC SPINE W/CONTRAS(T
|
Facility
|
OP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
610T0017
|
|
Hospital Revenue Code
|
612
|
| 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 THORACIC SPINE W/CONTRAST
|
Facility
|
IP
|
$3,997.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,199.10 |
| Max. Negotiated Rate |
$3,837.12 |
| Rate for Payer: Aetna Commercial |
$3,077.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,117.66
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$3,317.51
|
| Rate for Payer: First Health Commercial |
$3,797.15
|
| Rate for Payer: Humana Commercial |
$3,397.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,277.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,517.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,477.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,757.93
|
| Rate for Payer: PHCS Commercial |
$3,837.12
|
| Rate for Payer: United Healthcare All Payer |
$3,517.36
|
|
|
MRI THORACIC SPINE W/CONTRAST
|
Professional
|
Both
|
$3,997.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$2,398.20 |
| Rate for Payer: Aetna Commercial |
$800.22
|
| Rate for Payer: Ambetter Exchange |
$249.85
|
| Rate for Payer: Anthem Medicaid |
$445.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$249.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$249.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.82
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$905.67
|
| Rate for Payer: Healthspan PPO |
$549.87
|
| Rate for Payer: Humana Medicaid |
$445.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$249.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
| Rate for Payer: Molina Healthcare Passport |
$445.83
|
| Rate for Payer: Multiplan PHCS |
$2,398.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$324.81
|
| Rate for Payer: UHCCP Medicaid |
$1,398.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$249.85
|
|
|
MRI THORACIC SPINE W/CONTRAST
|
Facility
|
OP
|
$3,997.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
61000017
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,837.12 |
| Rate for Payer: Aetna Commercial |
$3,077.69
|
| Rate for Payer: Anthem Medicaid |
$1,374.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,117.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$3,317.51
|
| Rate for Payer: First Health Commercial |
$3,797.15
|
| Rate for Payer: Humana Commercial |
$3,397.45
|
| Rate for Payer: Humana KY Medicaid |
$1,374.57
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,388.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,277.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,517.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,477.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,757.93
|
| Rate for Payer: PHCS Commercial |
$3,837.12
|
| Rate for Payer: United Healthcare All Payer |
$3,517.36
|
|
|
MRI THORACIC SPINE W/O CON
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$654.05
|
| Rate for Payer: Ambetter Exchange |
$175.82
|
| Rate for Payer: Anthem Medicaid |
$405.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.98
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$825.01
|
| Rate for Payer: Healthspan PPO |
$449.43
|
| Rate for Payer: Humana Medicaid |
$405.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.12
|
| Rate for Payer: Molina Healthcare Passport |
$405.02
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.57
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.82
|
|
|
MRI THORACIC SPINE W/O CON
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
61000016
|
|
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 THORACIC SPINE W/O CON
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
61000016
|
|
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 THORACIC SPINE W/O CON(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
610P0016
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$825.01 |
| Rate for Payer: Aetna Commercial |
$654.05
|
| Rate for Payer: Ambetter Exchange |
$175.82
|
| Rate for Payer: Anthem Medicaid |
$405.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.98
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$825.01
|
| Rate for Payer: Healthspan PPO |
$449.43
|
| Rate for Payer: Humana Medicaid |
$405.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.12
|
| Rate for Payer: Molina Healthcare Passport |
$405.02
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.57
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.82
|
|
|
MRI THORACIC SPINE W/O CON(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
610T0016
|
|
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 THORACIC SPINE W/O CON(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
610T0016
|
|
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 UPPER EXTREMITY W/DYE
|
Professional
|
Both
|
$3,811.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
61000056
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$103.51 |
| Max. Negotiated Rate |
$2,286.60 |
| Rate for Payer: Aetna Commercial |
$771.55
|
| Rate for Payer: Ambetter Exchange |
$300.62
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.74
|
| Rate for Payer: Cash Price |
$1,905.50
|
| Rate for Payer: Cash Price |
$1,905.50
|
| Rate for Payer: Cigna Commercial |
$897.07
|
| Rate for Payer: Healthspan PPO |
$530.17
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,286.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.81
|
| Rate for Payer: UHCCP Medicaid |
$1,333.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.62
|
|
|
MRI UPPER EXTREMITY W/DYE
|
Facility
|
OP
|
$3,811.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
61000056
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,658.56 |
| Rate for Payer: Aetna Commercial |
$2,934.47
|
| Rate for Payer: Anthem Medicaid |
$1,310.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,972.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,905.50
|
| Rate for Payer: Cash Price |
$1,905.50
|
| Rate for Payer: Cigna Commercial |
$3,163.13
|
| Rate for Payer: First Health Commercial |
$3,620.45
|
| Rate for Payer: Humana Commercial |
$3,239.35
|
| Rate for Payer: Humana KY Medicaid |
$1,310.60
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,323.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,812.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,336.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,353.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,858.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,048.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.59
|
| Rate for Payer: PHCS Commercial |
$3,658.56
|
| Rate for Payer: United Healthcare All Payer |
$3,353.68
|
|
|
MRI UPPER EXTREMITY W/DYE
|
Facility
|
IP
|
$3,811.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
61000056
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,143.30 |
| Max. Negotiated Rate |
$3,658.56 |
| Rate for Payer: Aetna Commercial |
$2,934.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,972.58
|
| Rate for Payer: Cash Price |
$1,905.50
|
| Rate for Payer: Cigna Commercial |
$3,163.13
|
| Rate for Payer: First Health Commercial |
$3,620.45
|
| Rate for Payer: Humana Commercial |
$3,239.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,125.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,812.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,353.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,858.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,048.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.59
|
| Rate for Payer: PHCS Commercial |
$3,658.56
|
| Rate for Payer: United Healthcare All Payer |
$3,353.68
|
|
