|
MRI BRAIN W/O & W/DYE
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
61000053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$212.26 |
| Max. Negotiated Rate |
$2,271.99 |
| Rate for Payer: Aetna Commercial |
$2,271.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$659.00
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cigna Commercial |
$2,247.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.26
|
| Rate for Payer: Multiplan PHCS |
$395.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$461.30
|
| Rate for Payer: UHCCP Medicaid |
$230.65
|
|
|
MRI BRAIN W/O & W/DYE
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$514.02
|
| 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: 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 |
$197.70
|
| 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
|
|
|
MRI BRAIN W/O & W/DYE(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
610P0053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$2,271.99 |
| Rate for Payer: Aetna Commercial |
$2,271.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$2,247.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.26
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
|
|
MRI BRAIN W/O & W/DYE(T
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
610T0053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.52
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.04
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
MRI BRAIN W/O & W/DYE(T
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
610T0053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem Medicaid |
$97.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Humana KY Medicaid |
$97.67
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$98.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.04
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
MRI BRAIN W WO CONTRAST
|
Professional
|
Both
|
$4,349.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$4,349.00 |
| Rate for Payer: Aetna Commercial |
$1,005.91
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,349.00
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$1,502.58
|
| Rate for Payer: Healthspan PPO |
$691.21
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$2,609.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,044.30
|
| Rate for Payer: UHCCP Medicaid |
$1,522.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
|
|
MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem Medicaid |
$1,495.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Humana KY Medicaid |
$1,495.62
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,510.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,525.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.19
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
MRI BRAIN W WO CONTRAST
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$565.37 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.19
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
MRI BRAIN W WO CONTRAST(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
610P0010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$1,502.58 |
| Rate for Payer: Aetna Commercial |
$1,005.91
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$1,502.58
|
| Rate for Payer: Healthspan PPO |
$691.21
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
|
|
MRI BRAIN W WO CONTRAST(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
610T0010
|
|
Hospital Revenue Code
|
611
|
| 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 BRAIN W WO CONTRAST(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
610T0010
|
|
Hospital Revenue Code
|
611
|
| 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 BREAST BI WO CONT
|
Facility
|
OP
|
$3,624.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,479.04 |
| Rate for Payer: Aetna Commercial |
$2,790.48
|
| Rate for Payer: Anthem Medicaid |
$1,246.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,826.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Cigna Commercial |
$3,007.92
|
| Rate for Payer: First Health Commercial |
$3,442.80
|
| Rate for Payer: Humana Commercial |
$3,080.40
|
| Rate for Payer: Humana KY Medicaid |
$1,246.29
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,258.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,971.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,674.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,271.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,189.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,718.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.44
|
| Rate for Payer: PHCS Commercial |
$3,479.04
|
| Rate for Payer: United Healthcare All Payer |
$3,189.12
|
|
|
MRI BREAST BI WO CONT
|
Professional
|
Both
|
$3,624.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Anthem Medicaid |
$193.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,624.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Cigna Commercial |
$402.86
|
| Rate for Payer: Humana Medicaid |
$193.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.65
|
| Rate for Payer: Molina Healthcare Passport |
$193.77
|
| Rate for Payer: Multiplan PHCS |
$2,174.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,536.80
|
| Rate for Payer: UHCCP Medicaid |
$1,268.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.71
|
|
|
MRI BREAST BI WO CONT
|
Facility
|
IP
|
$3,624.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$471.12 |
| Max. Negotiated Rate |
$3,479.04 |
| Rate for Payer: Aetna Commercial |
$2,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,826.72
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Cigna Commercial |
$3,007.92
|
| Rate for Payer: First Health Commercial |
$3,442.80
|
| Rate for Payer: Humana Commercial |
$3,080.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,971.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,674.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,189.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,718.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.44
|
| Rate for Payer: PHCS Commercial |
$3,479.04
|
| Rate for Payer: United Healthcare All Payer |
$3,189.12
|
|
|
MRI BREAST BI WO CONT (P
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
610P0083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$402.86 |
| Rate for Payer: Anthem Medicaid |
$193.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$402.86
|
| Rate for Payer: Humana Medicaid |
$193.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.65
|
| Rate for Payer: Molina Healthcare Passport |
$193.77
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.71
|
|
|
MRI BREAST BI WO CONT (T
|
Facility
|
IP
|
$3,344.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
610T0083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$434.72 |
| Max. Negotiated Rate |
$3,210.24 |
| Rate for Payer: Aetna Commercial |
$2,574.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,608.32
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cigna Commercial |
$2,775.52
|
| Rate for Payer: First Health Commercial |
$3,176.80
|
| Rate for Payer: Humana Commercial |
$2,842.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,742.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,942.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,508.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,036.64
|
| Rate for Payer: PHCS Commercial |
$3,210.24
|
| Rate for Payer: United Healthcare All Payer |
$2,942.72
|
|
|
MRI BREAST BI WO CONT (T
|
Facility
|
OP
|
$3,344.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
610T0083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,210.24 |
| Rate for Payer: Aetna Commercial |
$2,574.88
|
| Rate for Payer: Anthem Medicaid |
$1,150.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,608.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cigna Commercial |
$2,775.52
|
| Rate for Payer: First Health Commercial |
$3,176.80
|
| Rate for Payer: Humana Commercial |
$2,842.40
|
| Rate for Payer: Humana KY Medicaid |
$1,150.00
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,161.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,742.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,173.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,942.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,508.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,036.64
|
| Rate for Payer: PHCS Commercial |
$3,210.24
|
| Rate for Payer: United Healthcare All Payer |
$2,942.72
|
|
|
MRI BREAST C-+ W/CAD BI
|
Facility
|
IP
|
$4,299.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$558.87 |
| Max. Negotiated Rate |
$4,127.04 |
| Rate for Payer: Aetna Commercial |
$3,310.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,353.22
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cigna Commercial |
$3,568.17
|
| Rate for Payer: First Health Commercial |
$4,084.05
|
| Rate for Payer: Humana Commercial |
$3,654.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,525.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,783.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.69
|
| Rate for Payer: PHCS Commercial |
$4,127.04
|
| Rate for Payer: United Healthcare All Payer |
$3,783.12
|
|
|
MRI BREAST C-+ W/CAD BI
|
Professional
|
Both
|
$4,299.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$146.81 |
| Max. Negotiated Rate |
$4,299.00 |
| Rate for Payer: Anthem Medicaid |
$305.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,299.00
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cigna Commercial |
$635.52
|
| Rate for Payer: Humana Medicaid |
$305.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.42
|
| Rate for Payer: Molina Healthcare Passport |
$305.31
|
| Rate for Payer: Multiplan PHCS |
$2,579.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,009.30
|
| Rate for Payer: UHCCP Medicaid |
$1,504.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.36
|
|
|
MRI BREAST C-+ W/CAD BI
|
Facility
|
OP
|
$4,299.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$558.87 |
| Max. Negotiated Rate |
$4,127.04 |
| Rate for Payer: Aetna Commercial |
$3,310.23
|
| Rate for Payer: Anthem Medicaid |
$1,478.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,353.22
|
| Rate for Payer: Cash Price |
$2,149.50
|
| Rate for Payer: Cigna Commercial |
$3,568.17
|
| Rate for Payer: First Health Commercial |
$4,084.05
|
| Rate for Payer: Humana Commercial |
$3,654.15
|
| Rate for Payer: Humana KY Medicaid |
$1,478.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,525.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,783.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.69
|
| Rate for Payer: PHCS Commercial |
$4,127.04
|
| Rate for Payer: United Healthcare All Payer |
$3,783.12
|
|
|
MRI BREAST C-+ W/CAD BI(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
610P0050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Anthem Medicaid |
$305.31
|
| 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 |
$635.52
|
| Rate for Payer: Humana Medicaid |
$305.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.42
|
| Rate for Payer: Molina Healthcare Passport |
$305.31
|
| 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 |
$308.36
|
|
|
MRI BREAST C-+ W/CAD BI(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
610T0050
|
|
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 BREAST C-+ W/CAD BI(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
610T0050
|
|
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 BREAST C-+ W/CAD UNI
|
Facility
|
IP
|
$4,114.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$534.82 |
| Max. Negotiated Rate |
$3,949.44 |
| Rate for Payer: Aetna Commercial |
$3,167.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,208.92
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$3,414.62
|
| Rate for Payer: First Health Commercial |
$3,908.30
|
| Rate for Payer: Humana Commercial |
$3,496.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.34
|
| Rate for Payer: PHCS Commercial |
$3,949.44
|
| Rate for Payer: United Healthcare All Payer |
$3,620.32
|
|
|
MRI BREAST C-+ W/CAD UNI
|
Facility
|
OP
|
$4,114.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$534.82 |
| Max. Negotiated Rate |
$3,949.44 |
| Rate for Payer: Aetna Commercial |
$3,167.78
|
| Rate for Payer: Anthem Medicaid |
$1,414.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,208.92
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$3,414.62
|
| Rate for Payer: First Health Commercial |
$3,908.30
|
| Rate for Payer: Humana Commercial |
$3,496.90
|
| Rate for Payer: Humana KY Medicaid |
$1,414.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.34
|
| Rate for Payer: PHCS Commercial |
$3,949.44
|
| Rate for Payer: United Healthcare All Payer |
$3,620.32
|
|
