|
MRI AXILA W/O CONTRAST
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
61000011
|
|
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
|
|
|
MRI AXILA W/O CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
610P0011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$803.80 |
| Rate for Payer: Aetna Commercial |
$638.52
|
| 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 |
$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 |
$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
|
|
|
MRI AXILA W/O CONTRAST(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
610T0011
|
|
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
|
|
|
MRI AXILA W/O CONTRAST(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
610T0011
|
|
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
|
|
|
MRI AXILA W WO CONTRAST
|
Facility
|
OP
|
$4,089.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,925.44 |
| Rate for Payer: Aetna Commercial |
$3,148.53
|
| Rate for Payer: Anthem Medicaid |
$1,406.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,189.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,044.50
|
| Rate for Payer: Cash Price |
$2,044.50
|
| Rate for Payer: Cigna Commercial |
$3,393.87
|
| Rate for Payer: First Health Commercial |
$3,884.55
|
| Rate for Payer: Humana Commercial |
$3,475.65
|
| Rate for Payer: Humana KY Medicaid |
$1,406.21
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,017.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,598.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.59
|
| Rate for Payer: PHCS Commercial |
$3,925.44
|
| Rate for Payer: United Healthcare All Payer |
$3,598.32
|
|
|
MRI AXILA W WO CONTRAST
|
Facility
|
IP
|
$4,089.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$531.57 |
| Max. Negotiated Rate |
$3,925.44 |
| Rate for Payer: Aetna Commercial |
$3,148.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,189.42
|
| Rate for Payer: Cash Price |
$2,044.50
|
| Rate for Payer: Cigna Commercial |
$3,393.87
|
| Rate for Payer: First Health Commercial |
$3,884.55
|
| Rate for Payer: Humana Commercial |
$3,475.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,017.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,598.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.59
|
| Rate for Payer: PHCS Commercial |
$3,925.44
|
| Rate for Payer: United Healthcare All Payer |
$3,598.32
|
|
|
MRI AXILA W WO CONTRAST
|
Professional
|
Both
|
$4,089.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$4,089.00 |
| Rate for Payer: Aetna Commercial |
$989.91
|
| Rate for Payer: Anthem Medicaid |
$717.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,089.00
|
| Rate for Payer: Cash Price |
$2,044.50
|
| Rate for Payer: Cash Price |
$2,044.50
|
| Rate for Payer: Cigna Commercial |
$1,518.36
|
| Rate for Payer: Healthspan PPO |
$680.22
|
| Rate for Payer: Humana Medicaid |
$717.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$732.35
|
| Rate for Payer: Molina Healthcare Passport |
$717.99
|
| Rate for Payer: Multiplan PHCS |
$2,453.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,862.30
|
| Rate for Payer: UHCCP Medicaid |
$1,431.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$725.17
|
|
|
MRI AXILA W WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
610P0012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,518.36 |
| Rate for Payer: Aetna Commercial |
$989.91
|
| Rate for Payer: Anthem Medicaid |
$717.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,518.36
|
| Rate for Payer: Healthspan PPO |
$680.22
|
| Rate for Payer: Humana Medicaid |
$717.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$732.35
|
| Rate for Payer: Molina Healthcare Passport |
$717.99
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$725.17
|
|
|
MRI AXILA W WO CONTRAST(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
610T0012
|
|
Hospital Revenue Code
|
610
|
| 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 WO CONTRAST(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
610T0012
|
|
Hospital Revenue Code
|
610
|
| 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 AZURE IPG W3SR01
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
MRI AZURE IPG W3SR01
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
MRI BRAIN W/CONTRAST
|
Professional
|
Both
|
$3,997.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
61000009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$3,997.00 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,997.00
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$922.79
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| Rate for Payer: Multiplan PHCS |
$2,398.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,797.90
|
| Rate for Payer: UHCCP Medicaid |
$1,398.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.27
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
OP
|
$3,997.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
61000009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,837.12 |
| Rate for Payer: Aetna Commercial |
$3,077.69
|
| Rate for Payer: Anthem Medicaid |
$1,374.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,117.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$3,317.51
|
| Rate for Payer: First Health Commercial |
$3,797.15
|
| Rate for Payer: Humana Commercial |
$3,397.45
|
| Rate for Payer: Humana KY Medicaid |
$1,374.57
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,388.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,277.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,517.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.07
|
| Rate for Payer: PHCS Commercial |
$3,837.12
|
| Rate for Payer: United Healthcare All Payer |
$3,517.36
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
IP
|
$3,997.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
61000009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$519.61 |
| Max. Negotiated Rate |
$3,837.12 |
| Rate for Payer: Aetna Commercial |
$3,077.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,117.66
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$3,317.51
|
| Rate for Payer: First Health Commercial |
$3,797.15
|
| Rate for Payer: Humana Commercial |
$3,397.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,277.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,517.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.07
|
| Rate for Payer: PHCS Commercial |
$3,837.12
|
| Rate for Payer: United Healthcare All Payer |
$3,517.36
|
|
|
MRI BRAIN W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
610P0009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$922.79 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| 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 |
$922.79
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| 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 |
$444.27
|
|
|
MRI BRAIN W/CONTRAST(T
|
Facility
|
OP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
610T0009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem Medicaid |
$1,271.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Humana KY Medicaid |
$1,271.40
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,284.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,296.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.07
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI BRAIN W/CONTRAST(T
|
Facility
|
IP
|
$3,697.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
610T0009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$480.61 |
| Max. Negotiated Rate |
$3,549.12 |
| Rate for Payer: Aetna Commercial |
$2,846.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,883.66
|
| Rate for Payer: Cash Price |
$1,848.50
|
| Rate for Payer: Cigna Commercial |
$3,068.51
|
| Rate for Payer: First Health Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial |
$3,142.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,031.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,728.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,253.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,772.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.07
|
| Rate for Payer: PHCS Commercial |
$3,549.12
|
| Rate for Payer: United Healthcare All Payer |
$3,253.36
|
|
|
MRI BRAIN W/O CONTRAST
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
61000008
|
|
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
|
|
|
MRI BRAIN W/O CONTRAST
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
61000008
|
|
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 BRAIN W/O CONTRAST
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
61000008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.86 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$643.74
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| 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 |
$788.67
|
| Rate for Payer: Healthspan PPO |
$442.34
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| 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 |
$369.96
|
|
|
MRI BRAIN W/O CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
610P0008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$788.67 |
| Rate for Payer: Aetna Commercial |
$643.74
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| 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 |
$788.67
|
| Rate for Payer: Healthspan PPO |
$442.34
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.86
|
| 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 |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI BRAIN W/O CONTRAST(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
610T0008
|
|
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
|
|
|
MRI BRAIN W/O CONTRAST(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
610T0008
|
|
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
|
|
|
MRI BRAIN W/O & W/DYE
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
61000053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$632.64 |
| Rate for Payer: Aetna Commercial |
$507.43
|
| Rate for Payer: Anthem Medicaid |
$226.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cigna Commercial |
$546.97
|
| Rate for Payer: First Health Commercial |
$626.05
|
| Rate for Payer: Humana Commercial |
$560.15
|
| Rate for Payer: Humana KY Medicaid |
$226.63
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$228.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$540.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$486.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$579.92
|
| Rate for Payer: Ohio Health Group HMO |
$494.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.29
|
| Rate for Payer: PHCS Commercial |
$632.64
|
| Rate for Payer: United Healthcare All Payer |
$579.92
|
|
