|
MRI ABD-CHOLANGIOG W AND WO CO
|
Facility
|
OP
|
$4,249.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,079.04 |
| Rate for Payer: Aetna Commercial |
$3,271.73
|
| Rate for Payer: Anthem Medicaid |
$1,461.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$3,526.67
|
| Rate for Payer: First Health Commercial |
$4,036.55
|
| Rate for Payer: Humana Commercial |
$3,611.65
|
| Rate for Payer: Humana KY Medicaid |
$1,461.23
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.19
|
| Rate for Payer: PHCS Commercial |
$4,079.04
|
| Rate for Payer: United Healthcare All Payer |
$3,739.12
|
|
|
MRI ABD-CHOLANGIOG W AND WO CO
|
Facility
|
IP
|
$4,249.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$552.37 |
| Max. Negotiated Rate |
$4,079.04 |
| Rate for Payer: Aetna Commercial |
$3,271.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.22
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$3,526.67
|
| Rate for Payer: First Health Commercial |
$4,036.55
|
| Rate for Payer: Humana Commercial |
$3,611.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.19
|
| Rate for Payer: PHCS Commercial |
$4,079.04
|
| Rate for Payer: United Healthcare All Payer |
$3,739.12
|
|
|
MRI ABD-CHOLANGIOG W AND WO CO
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$142.73 |
| Max. Negotiated Rate |
$4,249.00 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,249.00
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| 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 |
$2,549.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,974.30
|
| Rate for Payer: UHCCP Medicaid |
$1,487.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.72
|
|
|
MRI ABDOMEN W AND WO CO
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
610T0042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$519.87 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI ABDOMEN W AND WO CO
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
610T0042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem Medicaid |
$1,375.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Humana KY Medicaid |
$1,375.26
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI ABDOMEN W/CONTRAST
|
Professional
|
Both
|
$3,819.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$109.93 |
| Max. Negotiated Rate |
$3,819.00 |
| Rate for Payer: Healthspan PPO |
$536.49
|
| Rate for Payer: Humana Medicaid |
$405.62
|
| Rate for Payer: Aetna Commercial |
$780.75
|
| Rate for Payer: Anthem Medicaid |
$405.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,819.00
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$932.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.73
|
| Rate for Payer: Molina Healthcare Passport |
$405.62
|
| Rate for Payer: Multiplan PHCS |
$2,291.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,673.30
|
| Rate for Payer: UHCCP Medicaid |
$1,336.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.68
|
|
|
MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$3,819.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,666.24 |
| Rate for Payer: Aetna Commercial |
$2,940.63
|
| Rate for Payer: Anthem Medicaid |
$1,313.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,978.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$3,169.77
|
| Rate for Payer: First Health Commercial |
$3,628.05
|
| Rate for Payer: Humana Commercial |
$3,246.15
|
| Rate for Payer: Humana KY Medicaid |
$1,313.35
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,326.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,131.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,818.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,339.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,360.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,864.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$763.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$496.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,183.89
|
| Rate for Payer: PHCS Commercial |
$3,666.24
|
| Rate for Payer: United Healthcare All Payer |
$3,360.72
|
|
|
MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$3,819.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$496.47 |
| Max. Negotiated Rate |
$3,666.24 |
| Rate for Payer: Aetna Commercial |
$2,940.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,978.82
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$3,169.77
|
| Rate for Payer: First Health Commercial |
$3,628.05
|
| Rate for Payer: Humana Commercial |
$3,246.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,131.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,818.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,145.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,360.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,864.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$763.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$496.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,183.89
|
| Rate for Payer: PHCS Commercial |
$3,666.24
|
| Rate for Payer: United Healthcare All Payer |
$3,360.72
|
|
|
MRI ABDOMEN W/CONTRAST(P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
610P0057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$932.85 |
| Rate for Payer: Aetna Commercial |
$780.75
|
| Rate for Payer: Anthem Medicaid |
$405.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$290.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$932.85
|
| Rate for Payer: Healthspan PPO |
$536.49
|
| Rate for Payer: Humana Medicaid |
$405.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.73
|
| Rate for Payer: Molina Healthcare Passport |
$405.62
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$101.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.68
|
|
|
MRI ABDOMEN W/CONTRAST(T
|
Facility
|
OP
|
$3,529.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
610T0057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,387.84 |
| Rate for Payer: Aetna Commercial |
$2,717.33
|
| Rate for Payer: Anthem Medicaid |
$1,213.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,752.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,764.50
|
| Rate for Payer: Cash Price |
$1,764.50
|
| Rate for Payer: Cigna Commercial |
$2,929.07
|
| Rate for Payer: First Health Commercial |
$3,352.55
|
| Rate for Payer: Humana Commercial |
$2,999.65
|
| Rate for Payer: Humana KY Medicaid |
$1,213.62
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,225.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,893.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,604.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,237.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,105.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$705.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,093.99
|
| Rate for Payer: PHCS Commercial |
$3,387.84
|
| Rate for Payer: United Healthcare All Payer |
$3,105.52
|
|
|
MRI ABDOMEN W/CONTRAST(T
|
Facility
|
IP
|
$3,529.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
610T0057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$458.77 |
| Max. Negotiated Rate |
$3,387.84 |
| Rate for Payer: Aetna Commercial |
$2,717.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,752.62
|
| Rate for Payer: Cash Price |
$1,764.50
|
| Rate for Payer: Cigna Commercial |
$2,929.07
|
| Rate for Payer: First Health Commercial |
$3,352.55
|
| Rate for Payer: Humana Commercial |
$2,999.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,893.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,604.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,105.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$705.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,093.99
|
| Rate for Payer: PHCS Commercial |
$3,387.84
|
| Rate for Payer: United Healthcare All Payer |
$3,105.52
|
|
|
MRI ANGIO ABDOM W ORW/O DYE
|
Facility
|
IP
|
$2,863.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$372.19 |
| Max. Negotiated Rate |
$2,748.48 |
| Rate for Payer: Aetna Commercial |
$2,204.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,233.14
|
| Rate for Payer: Cash Price |
$1,431.50
|
| Rate for Payer: Cigna Commercial |
$2,376.29
|
| Rate for Payer: First Health Commercial |
$2,719.85
|
| Rate for Payer: Humana Commercial |
$2,433.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,347.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,112.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$858.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,519.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,147.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.53
|
| Rate for Payer: PHCS Commercial |
$2,748.48
|
| Rate for Payer: United Healthcare All Payer |
$2,519.44
|
|
|
MRI ANGIO ABDOM W ORW/O DYE
|
Facility
|
OP
|
$2,863.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$2,748.48 |
| Rate for Payer: Aetna Commercial |
$2,204.51
|
| Rate for Payer: Anthem Medicaid |
$984.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,233.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,431.50
|
| Rate for Payer: Cash Price |
$1,431.50
|
| Rate for Payer: Cigna Commercial |
$2,376.29
|
| Rate for Payer: First Health Commercial |
$2,719.85
|
| Rate for Payer: Humana Commercial |
$2,433.55
|
| Rate for Payer: Humana KY Medicaid |
$984.59
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$994.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,347.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,112.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,004.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,519.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,147.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.53
|
| Rate for Payer: PHCS Commercial |
$2,748.48
|
| Rate for Payer: United Healthcare All Payer |
$2,519.44
|
|
|
MRI ANGIO ABDOM W ORW/O DYE
|
Professional
|
Both
|
$2,863.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$114.23 |
| Max. Negotiated Rate |
$2,863.00 |
| Rate for Payer: Aetna Commercial |
$788.52
|
| Rate for Payer: Anthem Medicaid |
$377.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,863.00
|
| Rate for Payer: Cash Price |
$1,431.50
|
| Rate for Payer: Cash Price |
$1,431.50
|
| Rate for Payer: Cigna Commercial |
$818.48
|
| Rate for Payer: Healthspan PPO |
$541.83
|
| Rate for Payer: Humana Medicaid |
$377.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.09
|
| Rate for Payer: Molina Healthcare Passport |
$377.54
|
| Rate for Payer: Multiplan PHCS |
$1,717.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,004.10
|
| Rate for Payer: UHCCP Medicaid |
$1,002.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.32
|
|
|
MRI ANGIO ABDOM W ORW/O DYE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
610P0043
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$818.48 |
| Rate for Payer: Aetna Commercial |
$788.52
|
| Rate for Payer: Anthem Medicaid |
$377.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$818.48
|
| Rate for Payer: Healthspan PPO |
$541.83
|
| Rate for Payer: Humana Medicaid |
$377.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.09
|
| Rate for Payer: Molina Healthcare Passport |
$377.54
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.32
|
|
|
MRI ANGIO ABDOM W ORW/O DYE(T
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
610T0043
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$2,484.48 |
| Rate for Payer: Aetna Commercial |
$1,992.76
|
| Rate for Payer: Anthem Medicaid |
$890.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,018.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,294.00
|
| Rate for Payer: Cash Price |
$1,294.00
|
| Rate for Payer: Cigna Commercial |
$2,148.04
|
| Rate for Payer: First Health Commercial |
$2,458.60
|
| Rate for Payer: Humana Commercial |
$2,199.80
|
| Rate for Payer: Humana KY Medicaid |
$890.01
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$899.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,122.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$907.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,277.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,941.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$802.28
|
| Rate for Payer: PHCS Commercial |
$2,484.48
|
| Rate for Payer: United Healthcare All Payer |
$2,277.44
|
|
|
MRI ANGIO ABDOM W ORW/O DYE(T
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
610T0043
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$336.44 |
| Max. Negotiated Rate |
$2,484.48 |
| Rate for Payer: Aetna Commercial |
$1,992.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,018.64
|
| Rate for Payer: Cash Price |
$1,294.00
|
| Rate for Payer: Cigna Commercial |
$2,148.04
|
| Rate for Payer: First Health Commercial |
$2,458.60
|
| Rate for Payer: Humana Commercial |
$2,199.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,122.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,277.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,941.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$802.28
|
| Rate for Payer: PHCS Commercial |
$2,484.48
|
| Rate for Payer: United Healthcare All Payer |
$2,277.44
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
IP
|
$4,164.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$541.32 |
| Max. Negotiated Rate |
$3,997.44 |
| Rate for Payer: Aetna Commercial |
$3,206.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,247.92
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$3,456.12
|
| Rate for Payer: First Health Commercial |
$3,955.80
|
| Rate for Payer: Humana Commercial |
$3,539.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.84
|
| Rate for Payer: PHCS Commercial |
$3,997.44
|
| Rate for Payer: United Healthcare All Payer |
$3,664.32
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
OP
|
$4,164.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,997.44 |
| Rate for Payer: Aetna Commercial |
$3,206.28
|
| Rate for Payer: Anthem Medicaid |
$1,432.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,247.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$3,456.12
|
| Rate for Payer: First Health Commercial |
$3,955.80
|
| Rate for Payer: Humana Commercial |
$3,539.40
|
| Rate for Payer: Humana KY Medicaid |
$1,432.00
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,446.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,460.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.84
|
| Rate for Payer: PHCS Commercial |
$3,997.44
|
| Rate for Payer: United Healthcare All Payer |
$3,664.32
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Professional
|
Both
|
$4,164.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
61000013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$115.49 |
| Max. Negotiated Rate |
$4,164.00 |
| Rate for Payer: Aetna Commercial |
$789.97
|
| Rate for Payer: Anthem Medicaid |
$377.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,164.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Healthspan PPO |
$542.83
|
| Rate for Payer: Humana Medicaid |
$377.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.39
|
| Rate for Payer: Molina Healthcare Passport |
$377.83
|
| Rate for Payer: Multiplan PHCS |
$2,498.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,914.80
|
| Rate for Payer: UHCCP Medicaid |
$1,457.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.61
|
|
|
MRI ANGIO CHEST W OR W/O DY(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
610P0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Aetna Commercial |
$789.97
|
| Rate for Payer: Anthem Medicaid |
$377.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Healthspan PPO |
$542.83
|
| Rate for Payer: Humana Medicaid |
$377.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.39
|
| Rate for Payer: Molina Healthcare Passport |
$377.83
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.61
|
|
|
MRI ANGIO CHEST W OR W/O DY(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
610T0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRI ANGIO CHEST W OR W/O DY(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
610T0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRI AXILA W/O CONTRAST
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
61000011
|
|
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
|
|
|
MRI AXILA W/O CONTRAST
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$638.52
|
| 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 |
$803.80
|
| Rate for Payer: Healthspan PPO |
$438.76
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.15
|
| 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
|
|
