|
MRI ANGIO CHEST W OR W/O DY(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
610P0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Aetna Commercial |
$789.97
|
| Rate for Payer: Ambetter Exchange |
$304.19
|
| Rate for Payer: Anthem Medicaid |
$377.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$365.03
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Healthspan PPO |
$542.83
|
| Rate for Payer: Humana Medicaid |
$377.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.39
|
| Rate for Payer: Molina Healthcare Passport |
$377.83
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.45
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.19
|
|
|
MRI ANGIO CHEST W OR W/O DY(T
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
610T0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem Medicaid |
$1,415.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Humana KY Medicaid |
$1,415.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI ANGIO CHEST W OR W/O DY(T
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
610T0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI ANGIO CHEST W OR W/O DY(T
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
610T0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI ANGIO CHEST W OR W/O DY(T
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
HCPCS C8911
|
| Hospital Charge Code |
610T0013
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem Medicaid |
$1,415.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Humana KY Medicaid |
$1,415.15
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI AXILA W/O CONTRAST
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
61000011
|
|
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
|
|
|
MRI AXILA W/O CONTRAST
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
61000011
|
|
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
|
|
|
MRI AXILA W/O CONTRAST
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$638.52
|
| Rate for Payer: Ambetter Exchange |
$304.87
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$365.84
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$803.80
|
| Rate for Payer: Healthspan PPO |
$438.76
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.87
|
| 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 |
$396.33
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.87
|
|
|
MRI AXILA W/O CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
610P0011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$803.80 |
| Rate for Payer: Aetna Commercial |
$638.52
|
| Rate for Payer: Ambetter Exchange |
$304.87
|
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$365.84
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$803.80
|
| Rate for Payer: Healthspan PPO |
$438.76
|
| Rate for Payer: Humana Medicaid |
$371.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.87
|
| 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 |
$396.33
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.87
|
|
|
MRI AXILA W/O CONTRAST(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
610T0011
|
|
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
|
|
|
MRI AXILA W/O CONTRAST(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
610T0011
|
|
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
|
|
|
MRI AXILA W WO CONTRAST
|
Professional
|
Both
|
$4,340.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$2,604.00 |
| Rate for Payer: Aetna Commercial |
$989.91
|
| Rate for Payer: Ambetter Exchange |
$427.68
|
| Rate for Payer: Anthem Medicaid |
$717.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$513.22
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cigna Commercial |
$1,518.36
|
| Rate for Payer: Healthspan PPO |
$680.22
|
| Rate for Payer: Humana Medicaid |
$717.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$427.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$732.35
|
| Rate for Payer: Molina Healthcare Passport |
$717.99
|
| Rate for Payer: Multiplan PHCS |
$2,604.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.98
|
| Rate for Payer: UHCCP Medicaid |
$1,519.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$725.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.68
|
|
|
MRI AXILA W WO CONTRAST
|
Facility
|
IP
|
$4,340.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,302.00 |
| Max. Negotiated Rate |
$4,166.40 |
| Rate for Payer: Aetna Commercial |
$3,341.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,385.20
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cigna Commercial |
$3,602.20
|
| Rate for Payer: First Health Commercial |
$4,123.00
|
| Rate for Payer: Humana Commercial |
$3,689.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,558.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,202.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,775.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,994.60
|
| Rate for Payer: PHCS Commercial |
$4,166.40
|
| Rate for Payer: United Healthcare All Payer |
$3,819.20
|
|
|
MRI AXILA W WO CONTRAST
|
Facility
|
OP
|
$4,340.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
61000012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,166.40 |
| Rate for Payer: Aetna Commercial |
$3,341.80
|
| Rate for Payer: Anthem Medicaid |
$1,492.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,385.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cash Price |
$2,170.00
|
| Rate for Payer: Cigna Commercial |
$3,602.20
|
| Rate for Payer: First Health Commercial |
$4,123.00
|
| Rate for Payer: Humana Commercial |
$3,689.00
|
| Rate for Payer: Humana KY Medicaid |
$1,492.53
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,558.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,202.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,522.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,775.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,994.60
|
| Rate for Payer: PHCS Commercial |
$4,166.40
|
| Rate for Payer: United Healthcare All Payer |
$3,819.20
|
|
|
MRI AXILA W WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
610P0012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,518.36 |
| Rate for Payer: Aetna Commercial |
$989.91
|
| Rate for Payer: Ambetter Exchange |
$427.68
|
| Rate for Payer: Anthem Medicaid |
$717.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$513.22
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,518.36
|
| Rate for Payer: Healthspan PPO |
$680.22
|
| Rate for Payer: Humana Medicaid |
$717.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$427.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$732.35
|
| Rate for Payer: Molina Healthcare Passport |
$717.99
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.98
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$725.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.68
|
|
|
MRI AXILA W WO CONTRAST(T
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
610T0012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem Medicaid |
$1,415.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Humana KY Medicaid |
$1,415.15
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI AXILA W WO CONTRAST(T
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
610T0012
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,234.50 |
| Max. Negotiated Rate |
$3,950.40 |
| Rate for Payer: Aetna Commercial |
$3,168.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.70
|
| Rate for Payer: Cash Price |
$2,057.50
|
| Rate for Payer: Cigna Commercial |
$3,415.45
|
| Rate for Payer: First Health Commercial |
$3,909.25
|
| Rate for Payer: Humana Commercial |
$3,497.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,580.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.35
|
| Rate for Payer: PHCS Commercial |
$3,950.40
|
| Rate for Payer: United Healthcare All Payer |
$3,621.20
|
|
|
MRI AZURE IPG W3SR01
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
MRI AZURE IPG W3SR01
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
MRI BRAIN W/CONTRAST
|
Professional
|
Both
|
$4,237.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
61000009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$2,542.20 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Ambetter Exchange |
$248.37
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$248.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$248.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$298.04
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$922.79
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$248.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| Rate for Payer: Multiplan PHCS |
$2,542.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.88
|
| Rate for Payer: UHCCP Medicaid |
$1,482.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$248.37
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
OP
|
$4,237.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
61000009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,067.52 |
| Rate for Payer: Aetna Commercial |
$3,262.49
|
| Rate for Payer: Anthem Medicaid |
$1,457.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,304.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$3,516.71
|
| Rate for Payer: First Health Commercial |
$4,025.15
|
| Rate for Payer: Humana Commercial |
$3,601.45
|
| Rate for Payer: Humana KY Medicaid |
$1,457.10
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,471.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,474.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,126.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,486.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,728.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,686.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,923.53
|
| Rate for Payer: PHCS Commercial |
$4,067.52
|
| Rate for Payer: United Healthcare All Payer |
$3,728.56
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
IP
|
$4,237.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
61000009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,271.10 |
| Max. Negotiated Rate |
$4,067.52 |
| Rate for Payer: Aetna Commercial |
$3,262.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,304.86
|
| Rate for Payer: Cash Price |
$2,118.50
|
| Rate for Payer: Cigna Commercial |
$3,516.71
|
| Rate for Payer: First Health Commercial |
$4,025.15
|
| Rate for Payer: Humana Commercial |
$3,601.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,474.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,126.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,728.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,686.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,923.53
|
| Rate for Payer: PHCS Commercial |
$4,067.52
|
| Rate for Payer: United Healthcare All Payer |
$3,728.56
|
|
|
MRI BRAIN W/CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
610P0009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$922.79 |
| Rate for Payer: Aetna Commercial |
$787.70
|
| Rate for Payer: Ambetter Exchange |
$248.37
|
| Rate for Payer: Anthem Medicaid |
$439.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$248.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$248.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$298.04
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$922.79
|
| Rate for Payer: Healthspan PPO |
$541.27
|
| Rate for Payer: Humana Medicaid |
$439.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$248.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.67
|
| Rate for Payer: Molina Healthcare Passport |
$439.87
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$322.88
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$248.37
|
|
|
MRI BRAIN W/CONTRAST(T
|
Facility
|
IP
|
$3,937.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
610T0009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,181.10 |
| Max. Negotiated Rate |
$3,779.52 |
| Rate for Payer: Aetna Commercial |
$3,031.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.86
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cigna Commercial |
$3,267.71
|
| Rate for Payer: First Health Commercial |
$3,740.15
|
| Rate for Payer: Humana Commercial |
$3,346.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.53
|
| Rate for Payer: PHCS Commercial |
$3,779.52
|
| Rate for Payer: United Healthcare All Payer |
$3,464.56
|
|
|
MRI BRAIN W/CONTRAST(T
|
Facility
|
OP
|
$3,937.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
610T0009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,779.52 |
| Rate for Payer: Aetna Commercial |
$3,031.49
|
| Rate for Payer: Anthem Medicaid |
$1,353.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cash Price |
$1,968.50
|
| Rate for Payer: Cigna Commercial |
$3,267.71
|
| Rate for Payer: First Health Commercial |
$3,740.15
|
| Rate for Payer: Humana Commercial |
$3,346.45
|
| Rate for Payer: Humana KY Medicaid |
$1,353.93
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.53
|
| Rate for Payer: PHCS Commercial |
$3,779.52
|
| Rate for Payer: United Healthcare All Payer |
$3,464.56
|
|
