|
MRI UPPER EXTREMITY W/DYE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
610P0056
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$897.07 |
| 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 |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.81
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.62
|
|
|
MRI UPPER EXTREMITY W/DYE(T
|
Facility
|
IP
|
$3,611.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
610T0056
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,083.30 |
| Max. Negotiated Rate |
$3,466.56 |
| Rate for Payer: Aetna Commercial |
$2,780.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.58
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cigna Commercial |
$2,997.13
|
| Rate for Payer: First Health Commercial |
$3,430.45
|
| Rate for Payer: Humana Commercial |
$3,069.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,177.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,708.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,888.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,141.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.59
|
| Rate for Payer: PHCS Commercial |
$3,466.56
|
| Rate for Payer: United Healthcare All Payer |
$3,177.68
|
|
|
MRI UPPER EXTREMITY W/DYE(T
|
Facility
|
OP
|
$3,611.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
610T0056
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,466.56 |
| Rate for Payer: Aetna Commercial |
$2,780.47
|
| Rate for Payer: Anthem Medicaid |
$1,241.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cigna Commercial |
$2,997.13
|
| Rate for Payer: First Health Commercial |
$3,430.45
|
| Rate for Payer: Humana Commercial |
$3,069.35
|
| Rate for Payer: Humana KY Medicaid |
$1,241.82
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,266.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,177.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,708.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,888.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,141.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.59
|
| Rate for Payer: PHCS Commercial |
$3,466.56
|
| Rate for Payer: United Healthcare All Payer |
$3,177.68
|
|
|
MRI UPPER EXTREMITY W/O DYE
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
61000028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$2,296.20 |
| Rate for Payer: Aetna Commercial |
$629.14
|
| Rate for Payer: Ambetter Exchange |
$274.17
|
| Rate for Payer: Anthem Medicaid |
$333.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$274.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$274.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.00
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cash Price |
$1,913.50
|
| Rate for Payer: Cigna Commercial |
$771.89
|
| Rate for Payer: Healthspan PPO |
$432.31
|
| Rate for Payer: Humana Medicaid |
$333.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$274.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.20
|
| Rate for Payer: Molina Healthcare Passport |
$333.53
|
| Rate for Payer: Multiplan PHCS |
$2,296.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$356.42
|
| Rate for Payer: UHCCP Medicaid |
$1,339.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$274.17
|
|
|
MRI UPPER EXTREMITY W/O DYE
|
Facility
|
OP
|
$3,827.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
61000028
|
|
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 UPPER EXTREMITY W/O DYE
|
Facility
|
IP
|
$3,827.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
61000028
|
|
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 UPPER EXTREMITY W/O DYE(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
610P0028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$771.89 |
| Rate for Payer: Aetna Commercial |
$629.14
|
| Rate for Payer: Ambetter Exchange |
$274.17
|
| Rate for Payer: Anthem Medicaid |
$333.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$274.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$274.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$771.89
|
| Rate for Payer: Healthspan PPO |
$432.31
|
| Rate for Payer: Humana Medicaid |
$333.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$274.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.20
|
| Rate for Payer: Molina Healthcare Passport |
$333.53
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$356.42
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$274.17
|
|
|
MRI UPPER EXTREMITY W/O DYE(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
610T0028
|
|
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 UPPER EXTREMITY W/O DYE(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
610T0028
|
|
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 UPPR EXTREMITY W/O&W/DYE
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
61000029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.70 |
| Max. Negotiated Rate |
$2,705.40 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$373.10
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$373.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$373.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$447.72
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna Commercial |
$1,475.22
|
| 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 |
$136.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$373.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,705.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$485.03
|
| Rate for Payer: UHCCP Medicaid |
$1,578.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$373.10
|
|
|
MRI UPPR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$4,509.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
61000029
|
|
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 UPPR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$4,509.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
61000029
|
|
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 UPPR EXTREMITY W/O&W/DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
610P0029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,475.22 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Ambetter Exchange |
$373.10
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$373.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$373.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$447.72
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$1,475.22
|
| 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 |
$136.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$373.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$485.03
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$373.10
|
|
|
MRI UPPR EXTREMITY W/O&W/DY(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
610T0029
|
|
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 UPPR EXTREMITY W/O&W/DY(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
610T0029
|
|
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
|
|
|
MR SAFETY DETER PHYS/QHP
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 76016
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.62
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
MR SAFETY DETER PHYS/QHP
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 76016
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$78.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Humana KY Medicaid |
$78.75
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$79.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
MR SAFETY DETER PHYS/QHP
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 76016
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$137.40 |
| Rate for Payer: Ambetter Exchange |
$66.75
|
| Rate for Payer: Anthem Medicaid |
$58.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.10
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Humana Medicaid |
$58.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.97
|
| Rate for Payer: Molina Healthcare Passport |
$58.79
|
| Rate for Payer: Multiplan PHCS |
$137.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.78
|
| Rate for Payer: UHCCP Medicaid |
$80.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.75
|
|
|
MR SAFETY DETER PHYS/QHP (P
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 76016
|
| Hospital Charge Code |
610P0091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Ambetter Exchange |
$66.75
|
| Rate for Payer: Anthem Medicaid |
$58.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.10
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Humana Medicaid |
$58.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.97
|
| Rate for Payer: Molina Healthcare Passport |
$58.79
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.78
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.75
|
|
|
MR SAFETY DETER PHYS/QHP (T
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 76016
|
| Hospital Charge Code |
610T0091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.92
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
MR SAFETY DETER PHYS/QHP (T
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 76016
|
| Hospital Charge Code |
610T0091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$56.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Humana KY Medicaid |
$56.40
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$56.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
MR SAFETY IMPLANT ELEC PREPJ
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 76018
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$155.40 |
| Rate for Payer: Ambetter Exchange |
$103.98
|
| Rate for Payer: Anthem Medicaid |
$91.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.78
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Humana Medicaid |
$91.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.51
|
| Rate for Payer: Molina Healthcare Passport |
$91.68
|
| Rate for Payer: Multiplan PHCS |
$155.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.17
|
| Rate for Payer: UHCCP Medicaid |
$90.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.98
|
|
|
MR SAFETY IMPLANT ELEC PREPJ
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 76018
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$84.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.49
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$89.07
|
| Rate for Payer: Humana Medicare Advantage |
$84.81
|
| Rate for Payer: Kentucky WC Medicaid |
$89.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.71
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
MR SAFETY IMPLANT ELEC PREPJ
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 76018
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.71
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
MR SAFETY IMPLANT ELEC PREPJ(P
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 76018
|
| Hospital Charge Code |
610P0093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$135.17 |
| Rate for Payer: Ambetter Exchange |
$103.98
|
| Rate for Payer: Anthem Medicaid |
$91.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.78
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Humana Medicaid |
$91.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.51
|
| Rate for Payer: Molina Healthcare Passport |
$91.68
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.17
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.98
|
|
