|
MRI BRAIN W/O CONTRAST
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
61000008
|
|
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 BRAIN W/O CONTRAST
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
61000008
|
|
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 BRAIN W/O CONTRAST
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
61000008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.86 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$643.74
|
| Rate for Payer: Ambetter Exchange |
$180.83
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$788.67
|
| Rate for Payer: Healthspan PPO |
$442.34
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.08
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.83
|
|
|
MRI BRAIN W/O CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
610P0008
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$788.67 |
| Rate for Payer: Aetna Commercial |
$643.74
|
| Rate for Payer: Ambetter Exchange |
$180.83
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$180.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$788.67
|
| Rate for Payer: Healthspan PPO |
$442.34
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$180.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.08
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$180.83
|
|
|
MRI BRAIN W/O CONTRAST(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
610T0008
|
|
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 BRAIN W/O CONTRAST(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 70551
|
| Hospital Charge Code |
610T0008
|
|
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 BRAIN W/O & W/DYE
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
61000053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$632.64 |
| Rate for Payer: Aetna Commercial |
$507.43
|
| Rate for Payer: Anthem Medicaid |
$226.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cigna Commercial |
$546.97
|
| Rate for Payer: First Health Commercial |
$626.05
|
| Rate for Payer: Humana Commercial |
$560.15
|
| Rate for Payer: Humana KY Medicaid |
$226.63
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$228.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$540.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$486.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$579.92
|
| Rate for Payer: Ohio Health Group HMO |
$494.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$527.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$454.71
|
| Rate for Payer: PHCS Commercial |
$632.64
|
| Rate for Payer: United Healthcare All Payer |
$579.92
|
|
|
MRI BRAIN W/O & W/DYE
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
61000053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$197.70 |
| Max. Negotiated Rate |
$632.64 |
| Rate for Payer: Aetna Commercial |
$507.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.02
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cigna Commercial |
$546.97
|
| Rate for Payer: First Health Commercial |
$626.05
|
| Rate for Payer: Humana Commercial |
$560.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$540.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$486.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$579.92
|
| Rate for Payer: Ohio Health Group HMO |
$494.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$527.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$454.71
|
| Rate for Payer: PHCS Commercial |
$632.64
|
| Rate for Payer: United Healthcare All Payer |
$579.92
|
|
|
MRI BRAIN W/O & W/DYE
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
61000053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$212.26 |
| Max. Negotiated Rate |
$2,271.99 |
| Rate for Payer: Aetna Commercial |
$2,271.99
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cigna Commercial |
$2,247.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.26
|
| Rate for Payer: Multiplan PHCS |
$395.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$461.30
|
| Rate for Payer: UHCCP Medicaid |
$230.65
|
|
|
MRI BRAIN W/O & W/DYE(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
610P0053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$2,271.99 |
| Rate for Payer: Aetna Commercial |
$2,271.99
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$2,247.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.26
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
|
|
MRI BRAIN W/O & W/DYE(T
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
610T0053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$97.67 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem Medicaid |
$97.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Humana KY Medicaid |
$97.67
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$98.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.96
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
MRI BRAIN W/O & W/DYE(T
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 70559
|
| Hospital Charge Code |
610T0053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$272.64 |
| Rate for Payer: Aetna Commercial |
$218.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.52
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$235.72
|
| Rate for Payer: First Health Commercial |
$269.80
|
| Rate for Payer: Humana Commercial |
$241.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$209.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.92
|
| Rate for Payer: Ohio Health Group HMO |
$213.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.96
|
| Rate for Payer: PHCS Commercial |
$272.64
|
| Rate for Payer: United Healthcare All Payer |
$249.92
|
|
|
MRI BRAIN W WO CONTRAST
|
Professional
|
Both
|
$4,609.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$2,765.40 |
| Rate for Payer: Aetna Commercial |
$1,005.91
|
| Rate for Payer: Ambetter Exchange |
$293.35
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.02
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cigna Commercial |
$1,502.58
|
| Rate for Payer: Healthspan PPO |
$691.21
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$2,765.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.36
|
| Rate for Payer: UHCCP Medicaid |
$1,613.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.35
|
|
|
MRI BRAIN W WO CONTRAST
|
Facility
|
OP
|
$4,609.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,424.64 |
| Rate for Payer: Aetna Commercial |
$3,548.93
|
| Rate for Payer: Anthem Medicaid |
$1,585.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,595.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cigna Commercial |
$3,825.47
|
| Rate for Payer: First Health Commercial |
$4,378.55
|
| Rate for Payer: Humana Commercial |
$3,917.65
|
| Rate for Payer: Humana KY Medicaid |
$1,585.04
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,601.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,779.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,401.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,616.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,055.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,009.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,180.21
|
| Rate for Payer: PHCS Commercial |
$4,424.64
|
| Rate for Payer: United Healthcare All Payer |
$4,055.92
|
|
|
MRI BRAIN W WO CONTRAST
|
Facility
|
IP
|
$4,609.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,382.70 |
| Max. Negotiated Rate |
$4,424.64 |
| Rate for Payer: Aetna Commercial |
$3,548.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,595.02
|
| Rate for Payer: Cash Price |
$2,304.50
|
| Rate for Payer: Cigna Commercial |
$3,825.47
|
| Rate for Payer: First Health Commercial |
$4,378.55
|
| Rate for Payer: Humana Commercial |
$3,917.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,779.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,401.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,055.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,009.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,180.21
|
| Rate for Payer: PHCS Commercial |
$4,424.64
|
| Rate for Payer: United Healthcare All Payer |
$4,055.92
|
|
|
MRI BRAIN W WO CONTRAST(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
610P0010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$1,502.58 |
| Rate for Payer: Aetna Commercial |
$1,005.91
|
| Rate for Payer: Ambetter Exchange |
$293.35
|
| Rate for Payer: Anthem Medicaid |
$774.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.02
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$1,502.58
|
| Rate for Payer: Healthspan PPO |
$691.21
|
| Rate for Payer: Humana Medicaid |
$774.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$789.74
|
| Rate for Payer: Molina Healthcare Passport |
$774.25
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.36
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$781.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.35
|
|
|
MRI BRAIN W WO CONTRAST(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
610T0010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,088.64 |
| Rate for Payer: Aetna Commercial |
$3,279.43
|
| Rate for Payer: Anthem Medicaid |
$1,464.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cigna Commercial |
$3,534.97
|
| Rate for Payer: First Health Commercial |
$4,046.05
|
| Rate for Payer: Humana Commercial |
$3,620.15
|
| Rate for Payer: Humana KY Medicaid |
$1,464.67
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,705.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.71
|
| Rate for Payer: PHCS Commercial |
$4,088.64
|
| Rate for Payer: United Healthcare All Payer |
$3,747.92
|
|
|
MRI BRAIN W WO CONTRAST(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
610T0010
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,277.70 |
| Max. Negotiated Rate |
$4,088.64 |
| Rate for Payer: Aetna Commercial |
$3,279.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.02
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cigna Commercial |
$3,534.97
|
| Rate for Payer: First Health Commercial |
$4,046.05
|
| Rate for Payer: Humana Commercial |
$3,620.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,705.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.71
|
| Rate for Payer: PHCS Commercial |
$4,088.64
|
| Rate for Payer: United Healthcare All Payer |
$3,747.92
|
|
|
MRI BREAST BI WO CONT
|
Facility
|
IP
|
$3,841.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,152.30 |
| Max. Negotiated Rate |
$3,687.36 |
| Rate for Payer: Aetna Commercial |
$2,957.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,995.98
|
| Rate for Payer: Cash Price |
$1,920.50
|
| Rate for Payer: Cigna Commercial |
$3,188.03
|
| Rate for Payer: First Health Commercial |
$3,648.95
|
| Rate for Payer: Humana Commercial |
$3,264.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,149.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,834.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,152.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,380.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,341.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.29
|
| Rate for Payer: PHCS Commercial |
$3,687.36
|
| Rate for Payer: United Healthcare All Payer |
$3,380.08
|
|
|
MRI BREAST BI WO CONT
|
Facility
|
OP
|
$3,841.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,687.36 |
| Rate for Payer: Aetna Commercial |
$2,957.57
|
| Rate for Payer: Anthem Medicaid |
$1,320.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,995.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,920.50
|
| Rate for Payer: Cash Price |
$1,920.50
|
| Rate for Payer: Cigna Commercial |
$3,188.03
|
| Rate for Payer: First Health Commercial |
$3,648.95
|
| Rate for Payer: Humana Commercial |
$3,264.85
|
| Rate for Payer: Humana KY Medicaid |
$1,320.92
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,334.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,149.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,834.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,347.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,380.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,341.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.29
|
| Rate for Payer: PHCS Commercial |
$3,687.36
|
| Rate for Payer: United Healthcare All Payer |
$3,380.08
|
|
|
MRI BREAST BI WO CONT
|
Professional
|
Both
|
$3,841.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$2,304.60 |
| Rate for Payer: Ambetter Exchange |
$200.92
|
| Rate for Payer: Anthem Medicaid |
$193.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.10
|
| Rate for Payer: Cash Price |
$1,920.50
|
| Rate for Payer: Cash Price |
$1,920.50
|
| Rate for Payer: Cigna Commercial |
$402.86
|
| Rate for Payer: Humana Medicaid |
$193.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.65
|
| Rate for Payer: Molina Healthcare Passport |
$193.77
|
| Rate for Payer: Multiplan PHCS |
$2,304.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$261.20
|
| Rate for Payer: UHCCP Medicaid |
$1,344.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.92
|
|
|
MRI BREAST BI WO CONT (P
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
610P0083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$402.86 |
| Rate for Payer: Ambetter Exchange |
$200.92
|
| Rate for Payer: Anthem Medicaid |
$193.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.10
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$402.86
|
| Rate for Payer: Humana Medicaid |
$193.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.65
|
| Rate for Payer: Molina Healthcare Passport |
$193.77
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$261.20
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.92
|
|
|
MRI BREAST BI WO CONT (T
|
Facility
|
IP
|
$3,561.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
610T0083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,068.30 |
| Max. Negotiated Rate |
$3,418.56 |
| Rate for Payer: Aetna Commercial |
$2,741.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,777.58
|
| Rate for Payer: Cash Price |
$1,780.50
|
| Rate for Payer: Cigna Commercial |
$2,955.63
|
| Rate for Payer: First Health Commercial |
$3,382.95
|
| Rate for Payer: Humana Commercial |
$3,026.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,920.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,628.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,133.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,670.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,098.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,457.09
|
| Rate for Payer: PHCS Commercial |
$3,418.56
|
| Rate for Payer: United Healthcare All Payer |
$3,133.68
|
|
|
MRI BREAST BI WO CONT (T
|
Facility
|
OP
|
$3,561.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
610T0083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,418.56 |
| Rate for Payer: Aetna Commercial |
$2,741.97
|
| Rate for Payer: Anthem Medicaid |
$1,224.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,777.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,780.50
|
| Rate for Payer: Cash Price |
$1,780.50
|
| Rate for Payer: Cigna Commercial |
$2,955.63
|
| Rate for Payer: First Health Commercial |
$3,382.95
|
| Rate for Payer: Humana Commercial |
$3,026.85
|
| Rate for Payer: Humana KY Medicaid |
$1,224.63
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,237.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,920.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,628.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,249.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,133.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,670.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,098.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,457.09
|
| Rate for Payer: PHCS Commercial |
$3,418.56
|
| Rate for Payer: United Healthcare All Payer |
$3,133.68
|
|
|
MRI BREAST C-+ W/CAD BI
|
Professional
|
Both
|
$4,559.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$146.81 |
| Max. Negotiated Rate |
$2,735.40 |
| Rate for Payer: Ambetter Exchange |
$314.01
|
| Rate for Payer: Anthem Medicaid |
$305.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.81
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$635.52
|
| Rate for Payer: Humana Medicaid |
$305.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.42
|
| Rate for Payer: Molina Healthcare Passport |
$305.31
|
| Rate for Payer: Multiplan PHCS |
$2,735.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$408.21
|
| Rate for Payer: UHCCP Medicaid |
$1,595.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.01
|
|
