|
MR brain radiation planning (T
|
Facility
|
OP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
610T0084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem Medicaid |
$707.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Humana KY Medicaid |
$707.75
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$714.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.98
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
MR brain radiation planning (T
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
610T0084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.98
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
MRCP (MR CHOLOANGIOGRAM)
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
61000041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$640.28
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,679.00
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cigna Commercial |
$751.97
|
| Rate for Payer: Healthspan PPO |
$439.97
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$2,207.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,575.30
|
| Rate for Payer: UHCCP Medicaid |
$1,287.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
|
|
MRCP (MR CHOLOANGIOGRAM)
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
61000041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,531.84 |
| Rate for Payer: Aetna Commercial |
$2,832.83
|
| Rate for Payer: Anthem Medicaid |
$1,265.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,869.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cigna Commercial |
$3,053.57
|
| Rate for Payer: First Health Commercial |
$3,495.05
|
| Rate for Payer: Humana Commercial |
$3,127.15
|
| Rate for Payer: Humana KY Medicaid |
$1,265.21
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,278.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,016.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,715.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,290.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,237.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.49
|
| Rate for Payer: PHCS Commercial |
$3,531.84
|
| Rate for Payer: United Healthcare All Payer |
$3,237.52
|
|
|
MRCP (MR CHOLOANGIOGRAM)
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
61000041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$478.27 |
| Max. Negotiated Rate |
$3,531.84 |
| Rate for Payer: Aetna Commercial |
$2,832.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,869.62
|
| Rate for Payer: Cash Price |
$1,839.50
|
| Rate for Payer: Cigna Commercial |
$3,053.57
|
| Rate for Payer: First Health Commercial |
$3,495.05
|
| Rate for Payer: Humana Commercial |
$3,127.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,016.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,715.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,103.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,237.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.49
|
| Rate for Payer: PHCS Commercial |
$3,531.84
|
| Rate for Payer: United Healthcare All Payer |
$3,237.52
|
|
|
MRCP (MR CHOLOANGIOGRAM)(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
610P0041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$751.97 |
| Rate for Payer: Aetna Commercial |
$640.28
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$751.97
|
| Rate for Payer: Healthspan PPO |
$439.97
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
|
|
MRCP (MR CHOLOANGIOGRAM)(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
610T0041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$445.77 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MRCP (MR CHOLOANGIOGRAM)(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
610T0041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem Medicaid |
$1,179.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Humana KY Medicaid |
$1,179.23
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MRG DISABILITY DETERMINATION
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
MRG DISABILITY DETERMINATION
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.71 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$2,172.84
|
| Rate for Payer: Anthem Medicaid |
$994.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,347.33
|
| Rate for Payer: Healthspan PPO |
$1,968.13
|
| Rate for Payer: Humana Medicaid |
$994.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,871.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.60
|
| Rate for Payer: Molina Healthcare Passport |
$994.71
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.66
|
|
|
MRG DISABILITY DETERMINATION
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
MRG DISABILITY DETERMINATION(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
761P0418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.71 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$2,172.84
|
| Rate for Payer: Anthem Medicaid |
$994.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,347.33
|
| Rate for Payer: Healthspan PPO |
$1,968.13
|
| Rate for Payer: Humana Medicaid |
$994.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,871.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.60
|
| Rate for Payer: Molina Healthcare Passport |
$994.71
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.66
|
|
|
MRI 3D WITH INDEP WORKSTATION
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem Medicaid |
$381.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Humana KY Medicaid |
$381.39
|
| Rate for Payer: Kentucky WC Medicaid |
$385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
MRI 3D WITH INDEP WORKSTATION
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,109.00
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$665.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$776.30
|
| Rate for Payer: UHCCP Medicaid |
$388.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
|
|
MRI 3D WITH INDEP WORKSTATION
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
MRI 3D WITH INDEP WORKSTATIO(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400P0002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
|
|
MRI 3D WITH INDEP WORKSTATIO(T
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem Medicaid |
$321.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Humana KY Medicaid |
$321.20
|
| Rate for Payer: Kentucky WC Medicaid |
$324.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$327.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
MRI 3D WITH INDEP WORKSTATIO(T
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
MRI 3D WO INDEP WORKSTATION
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40000001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$927.00
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$648.90
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
|
|
MRI 3D WO INDEP WORKSTATION
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40000001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
MRI 3D WO INDEP WORKSTATION
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40000001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
MRI 3D WO INDEP WORKSTATION(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
400P0001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$178.97 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
|
|
MRI 3D WO INDEP WORKSTATION(T
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
400T0001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
MRI 3D WO INDEP WORKSTATION(T
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
400T0001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
MRI ABD-CHOLANGIOG W AND WO CO
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
610P0042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,485.65 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$1,485.65
|
| 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 |
$142.73
|
| 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 |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.72
|
|
