|
MRI BREAST C-+ W/CAD UNI
|
Professional
|
Both
|
$4,114.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: Anthem Medicaid |
$298.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,114.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$621.53
|
| Rate for Payer: Humana Medicaid |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.32
|
| Rate for Payer: Molina Healthcare Passport |
$298.35
|
| Rate for Payer: Multiplan PHCS |
$2,468.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,879.80
|
| Rate for Payer: UHCCP Medicaid |
$1,439.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.33
|
|
|
MRI BREAST C-+ W/CAD UNI(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
610P0049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$621.53 |
| Rate for Payer: Anthem Medicaid |
$298.35
|
| 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 |
$621.53
|
| Rate for Payer: Humana Medicaid |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.32
|
| Rate for Payer: Molina Healthcare Passport |
$298.35
|
| 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 |
$301.33
|
|
|
MRI BREAST C-+ W/CAD UNI(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
610T0049
|
|
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 BREAST C-+ W/CAD UNI(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
610T0049
|
|
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 Medicaid |
$1,328.83
|
| 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: Humana KY Medicaid |
$1,328.83
|
| 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 |
$1,159.20
|
| 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 CARDIAC W AND W/O CON
|
Professional
|
Both
|
$4,274.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
61000045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$167.36 |
| Max. Negotiated Rate |
$4,274.00 |
| Rate for Payer: Aetna Commercial |
$1,032.80
|
| Rate for Payer: Anthem Medicaid |
$475.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,274.00
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$1,077.03
|
| Rate for Payer: Healthspan PPO |
$709.69
|
| Rate for Payer: Humana Medicaid |
$475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.09
|
| Rate for Payer: Molina Healthcare Passport |
$475.58
|
| Rate for Payer: Multiplan PHCS |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,991.80
|
| Rate for Payer: UHCCP Medicaid |
$1,495.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.34
|
|
|
MRI CARDIAC W AND W/O CON
|
Facility
|
IP
|
$4,274.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
61000045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$555.62 |
| Max. Negotiated Rate |
$4,103.04 |
| Rate for Payer: Aetna Commercial |
$3,290.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.72
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$3,547.42
|
| Rate for Payer: First Health Commercial |
$4,060.30
|
| Rate for Payer: Humana Commercial |
$3,632.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.94
|
| Rate for Payer: PHCS Commercial |
$4,103.04
|
| Rate for Payer: United Healthcare All Payer |
$3,761.12
|
|
|
MRI CARDIAC W AND W/O CON
|
Facility
|
OP
|
$4,274.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
61000045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,103.04 |
| Rate for Payer: Aetna Commercial |
$3,290.98
|
| Rate for Payer: Anthem Medicaid |
$1,469.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$3,547.42
|
| Rate for Payer: First Health Commercial |
$4,060.30
|
| Rate for Payer: Humana Commercial |
$3,632.90
|
| Rate for Payer: Humana KY Medicaid |
$1,469.83
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.94
|
| Rate for Payer: PHCS Commercial |
$4,103.04
|
| Rate for Payer: United Healthcare All Payer |
$3,761.12
|
|
|
MRI CARDIAC W AND W/O CON(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
610P0045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$1,077.03 |
| Rate for Payer: Aetna Commercial |
$1,032.80
|
| Rate for Payer: Anthem Medicaid |
$475.58
|
| 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 |
$1,077.03
|
| Rate for Payer: Healthspan PPO |
$709.69
|
| Rate for Payer: Humana Medicaid |
$475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.09
|
| Rate for Payer: Molina Healthcare Passport |
$475.58
|
| 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 |
$480.34
|
|
|
MRI CARDIAC W AND W/O CON(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
610T0045
|
|
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 CARDIAC W AND W/O CON(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
610T0045
|
|
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 CARDIAC W/O CONTRAST
|
Professional
|
Both
|
$3,679.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: Aetna Commercial |
$726.36
|
| Rate for Payer: Anthem Medicaid |
$309.93
|
| 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 |
$798.65
|
| Rate for Payer: Healthspan PPO |
$499.11
|
| Rate for Payer: Humana Medicaid |
$309.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.13
|
| Rate for Payer: Molina Healthcare Passport |
$309.93
|
| 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 |
$313.03
|
|
|
MRI CARDIAC W/O CONTRAST
|
Facility
|
OP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
61000044
|
|
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 CARDIAC W/O CONTRAST
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
61000044
|
|
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 CARDIAC W/O CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
610P0044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$798.65 |
| Rate for Payer: Aetna Commercial |
$726.36
|
| Rate for Payer: Anthem Medicaid |
$309.93
|
| 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 |
$798.65
|
| Rate for Payer: Healthspan PPO |
$499.11
|
| Rate for Payer: Humana Medicaid |
$309.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.13
|
| Rate for Payer: Molina Healthcare Passport |
$309.93
|
| 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 |
$313.03
|
|
|
MRI CARDIAC W/O CONTRAST(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
610T0044
|
|
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 CARDIAC W/O CONTRAST(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
610T0044
|
|
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 CERVICAL SPINE W CONTRAS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
610P0015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$933.24 |
| Rate for Payer: Aetna Commercial |
$798.63
|
| Rate for Payer: Anthem Medicaid |
$445.83
|
| 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 |
$933.24
|
| Rate for Payer: Healthspan PPO |
$548.78
|
| Rate for Payer: Humana Medicaid |
$445.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
| Rate for Payer: Molina Healthcare Passport |
$445.83
|
| 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 |
$450.29
|
|
|
MRI CERVICAL SPINE W CONTRAS(T
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
610T0015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem Medicaid |
$1,228.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Humana KY Medicaid |
$1,228.41
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
MRI CERVICAL SPINE W CONTRAS(T
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
610T0015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
MRI CERVICAL SPINE W CONTRAST
|
Facility
|
OP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,717.12 |
| Rate for Payer: Aetna Commercial |
$2,981.44
|
| Rate for Payer: Anthem Medicaid |
$1,331.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,020.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$3,213.76
|
| Rate for Payer: First Health Commercial |
$3,678.40
|
| Rate for Payer: Humana Commercial |
$3,291.20
|
| Rate for Payer: Humana KY Medicaid |
$1,331.58
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,345.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,175.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,857.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,358.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,407.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,904.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.32
|
| Rate for Payer: PHCS Commercial |
$3,717.12
|
| Rate for Payer: United Healthcare All Payer |
$3,407.36
|
|
|
MRI CERVICAL SPINE W CONTRAST
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$3,872.00 |
| Rate for Payer: Aetna Commercial |
$798.63
|
| Rate for Payer: Anthem Medicaid |
$445.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,872.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$933.24
|
| Rate for Payer: Healthspan PPO |
$548.78
|
| Rate for Payer: Humana Medicaid |
$445.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$454.75
|
| Rate for Payer: Molina Healthcare Passport |
$445.83
|
| Rate for Payer: Multiplan PHCS |
$2,323.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,710.40
|
| Rate for Payer: UHCCP Medicaid |
$1,355.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.29
|
|
|
MRI CERVICAL SPINE W CONTRAST
|
Facility
|
IP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
61000015
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$503.36 |
| Max. Negotiated Rate |
$3,717.12 |
| Rate for Payer: Aetna Commercial |
$2,981.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,020.16
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$3,213.76
|
| Rate for Payer: First Health Commercial |
$3,678.40
|
| Rate for Payer: Humana Commercial |
$3,291.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,175.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,857.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,407.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,904.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.32
|
| Rate for Payer: PHCS Commercial |
$3,717.12
|
| Rate for Payer: United Healthcare All Payer |
$3,407.36
|
|
|
MRI CERVICAL SPINE WO CONTRAST
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
610T0014
|
|
Hospital Revenue Code
|
612
|
| 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 CERVICAL SPINE WO CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
610P0014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$770.90 |
| Rate for Payer: Aetna Commercial |
$653.15
|
| 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 |
$770.90
|
| Rate for Payer: Healthspan PPO |
$448.81
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.22
|
| 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 CERVICAL SPINE WO CONTRAST
|
Facility
|
IP
|
$3,679.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
61000014
|
|
Hospital Revenue Code
|
612
|
| 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
|
|
