|
MR brain radiation planning (T
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
610T0084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,790.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.02
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
MRCP (MR CHOLOANGIOGRAM)
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
61000041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$640.28
|
| Rate for Payer: Ambetter Exchange |
$179.89
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$179.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$179.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$215.87
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$751.97
|
| Rate for Payer: Healthspan PPO |
$439.97
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$179.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.10
|
| Rate for Payer: Molina Healthcare Passport |
$371.67
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$233.86
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$179.89
|
|
|
MRCP (MR CHOLOANGIOGRAM)
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
61000041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem Medicaid |
$1,341.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Humana KY Medicaid |
$1,341.90
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.38
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
MRCP (MR CHOLOANGIOGRAM)
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
61000041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,170.60 |
| Max. Negotiated Rate |
$3,745.92 |
| Rate for Payer: Aetna Commercial |
$3,004.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.56
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$3,238.66
|
| Rate for Payer: First Health Commercial |
$3,706.90
|
| Rate for Payer: Humana Commercial |
$3,316.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,692.38
|
| Rate for Payer: PHCS Commercial |
$3,745.92
|
| Rate for Payer: United Healthcare All Payer |
$3,433.76
|
|
|
MRCP (MR CHOLOANGIOGRAM)(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
610P0041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$751.97 |
| Rate for Payer: Aetna Commercial |
$640.28
|
| Rate for Payer: Ambetter Exchange |
$179.89
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$179.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$179.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$215.87
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$751.97
|
| Rate for Payer: Healthspan PPO |
$439.97
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$179.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.89
|
| 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 |
$233.86
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$179.89
|
|
|
MRCP (MR CHOLOANGIOGRAM)(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
610T0041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem Medicaid |
$1,255.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Humana KY Medicaid |
$1,255.92
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MRCP (MR CHOLOANGIOGRAM)(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
610T0041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MRG DISABILITY DETERMINATION
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
MRG DISABILITY DETERMINATION
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
MRG DISABILITY DETERMINATION
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.71 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$2,172.84
|
| Rate for Payer: Ambetter Exchange |
$1,698.12
|
| Rate for Payer: Anthem Medicaid |
$994.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,698.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,698.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,037.74
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,347.33
|
| Rate for Payer: Healthspan PPO |
$1,968.13
|
| Rate for Payer: Humana Medicaid |
$994.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,871.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,698.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,698.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.60
|
| Rate for Payer: Molina Healthcare Passport |
$994.71
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,207.56
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,698.12
|
|
|
MRG DISABILITY DETERMINATION(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 22222
|
| Hospital Charge Code |
761P0418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.71 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$2,172.84
|
| Rate for Payer: Ambetter Exchange |
$1,698.12
|
| Rate for Payer: Anthem Medicaid |
$994.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,698.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,698.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,037.74
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$2,347.33
|
| Rate for Payer: Healthspan PPO |
$1,968.13
|
| Rate for Payer: Humana Medicaid |
$994.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,871.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,698.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,698.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.60
|
| Rate for Payer: Molina Healthcare Passport |
$994.71
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,207.56
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,698.12
|
|
|
MRI 3D WITH INDEP WORKSTATION
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
MRI 3D WITH INDEP WORKSTATION
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$72.64
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.17
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.43
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.64
|
|
|
MRI 3D WITH INDEP WORKSTATION
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
MRI 3D WITH INDEP WORKSTATIO(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400P0002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$72.64
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.17
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.43
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.64
|
|
|
MRI 3D WITH INDEP WORKSTATIO(T
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$955.20 |
| Rate for Payer: Aetna Commercial |
$766.15
|
| Rate for Payer: Anthem Medicaid |
$342.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$776.10
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$825.85
|
| Rate for Payer: First Health Commercial |
$945.25
|
| Rate for Payer: Humana Commercial |
$845.75
|
| Rate for Payer: Humana KY Medicaid |
$342.18
|
| Rate for Payer: Kentucky WC Medicaid |
$345.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$734.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$349.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$875.60
|
| Rate for Payer: Ohio Health Group HMO |
$746.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.55
|
| Rate for Payer: PHCS Commercial |
$955.20
|
| Rate for Payer: United Healthcare All Payer |
$875.60
|
|
|
MRI 3D WITH INDEP WORKSTATIO(T
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0002
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$298.50 |
| Max. Negotiated Rate |
$955.20 |
| Rate for Payer: Aetna Commercial |
$766.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$776.10
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$825.85
|
| Rate for Payer: First Health Commercial |
$945.25
|
| Rate for Payer: Humana Commercial |
$845.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$734.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$875.60
|
| Rate for Payer: Ohio Health Group HMO |
$746.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.55
|
| Rate for Payer: PHCS Commercial |
$955.20
|
| Rate for Payer: United Healthcare All Payer |
$875.60
|
|
|
MRI 3D WO INDEP WORKSTATION
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40000001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Ambetter Exchange |
$23.34
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.01
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.34
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.34
|
|
|
MRI 3D WO INDEP WORKSTATION
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40000001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
MRI 3D WO INDEP WORKSTATION
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40000001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
MRI 3D WO INDEP WORKSTATION(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
400P0001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$178.97 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Ambetter Exchange |
$23.34
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.01
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.34
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.34
|
|
|
MRI 3D WO INDEP WORKSTATION(T
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
400T0001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.05
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
MRI 3D WO INDEP WORKSTATION(T
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
400T0001
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem Medicaid |
$324.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Humana KY Medicaid |
$324.99
|
| Rate for Payer: Kentucky WC Medicaid |
$328.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$331.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.05
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
MRI ABD-CHOLANGIOG W AND WO CO
|
Facility
|
OP
|
$4,509.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,328.64 |
| Rate for Payer: Aetna Commercial |
$3,471.93
|
| Rate for Payer: Anthem Medicaid |
$1,550.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,517.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna Commercial |
$3,742.47
|
| Rate for Payer: First Health Commercial |
$4,283.55
|
| Rate for Payer: Humana Commercial |
$3,832.65
|
| Rate for Payer: Humana KY Medicaid |
$1,550.65
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,566.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,697.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,327.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,581.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,967.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,607.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,922.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,111.21
|
| Rate for Payer: PHCS Commercial |
$4,328.64
|
| Rate for Payer: United Healthcare All Payer |
$3,967.92
|
|
|
MRI ABD-CHOLANGIOG W AND WO CO
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
61000042
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$142.73 |
| Max. Negotiated Rate |
$2,705.40 |
| Rate for Payer: Aetna Commercial |
$993.42
|
| Rate for Payer: Ambetter Exchange |
$309.85
|
| Rate for Payer: Anthem Medicaid |
$723.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.82
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cash Price |
$2,254.50
|
| Rate for Payer: Cigna Commercial |
$1,485.65
|
| Rate for Payer: Healthspan PPO |
$682.63
|
| Rate for Payer: Humana Medicaid |
$723.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$309.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.96
|
| Rate for Payer: Molina Healthcare Passport |
$723.49
|
| Rate for Payer: Multiplan PHCS |
$2,705.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.81
|
| Rate for Payer: UHCCP Medicaid |
$1,578.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.85
|
|
