|
MRI BREAST C-+ W/CAD BI
|
Facility
|
OP
|
$4,559.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,367.70 |
| Max. Negotiated Rate |
$4,376.64 |
| Rate for Payer: Aetna Commercial |
$3,510.43
|
| Rate for Payer: Anthem Medicaid |
$1,567.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,556.02
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$3,783.97
|
| Rate for Payer: First Health Commercial |
$4,331.05
|
| Rate for Payer: Humana Commercial |
$3,875.15
|
| Rate for Payer: Humana KY Medicaid |
$1,567.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,583.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,738.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,364.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,599.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,011.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,966.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,145.71
|
| Rate for Payer: PHCS Commercial |
$4,376.64
|
| Rate for Payer: United Healthcare All Payer |
$4,011.92
|
|
|
MRI BREAST C-+ W/CAD BI
|
Facility
|
IP
|
$4,559.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,367.70 |
| Max. Negotiated Rate |
$4,376.64 |
| Rate for Payer: Aetna Commercial |
$3,510.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,556.02
|
| Rate for Payer: Cash Price |
$2,279.50
|
| Rate for Payer: Cigna Commercial |
$3,783.97
|
| Rate for Payer: First Health Commercial |
$4,331.05
|
| Rate for Payer: Humana Commercial |
$3,875.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,738.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,364.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,011.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,966.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,145.71
|
| Rate for Payer: PHCS Commercial |
$4,376.64
|
| Rate for Payer: United Healthcare All Payer |
$4,011.92
|
|
|
MRI BREAST C-+ W/CAD BI(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
610P0050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: 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 |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$635.52
|
| Rate for Payer: Humana Medicaid |
$305.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.81
|
| Rate for Payer: 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 |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$408.21
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.01
|
|
|
MRI BREAST C-+ W/CAD BI(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
610T0050
|
|
Hospital Revenue Code
|
610
|
| 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 BREAST C-+ W/CAD BI(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
610T0050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,277.70 |
| 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 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: Humana KY Medicaid |
$1,464.67
|
| 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 |
$1,277.70
|
| 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 BREAST C-+ W/CAD BI(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
610T0050
|
|
Hospital Revenue Code
|
610
|
| 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 C-+ W/CAD BI(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
610T0050
|
|
Hospital Revenue Code
|
610
|
| 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 C-+ W/CAD UNI
|
Facility
|
IP
|
$4,114.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,234.20 |
| Max. Negotiated Rate |
$3,949.44 |
| Rate for Payer: Aetna Commercial |
$3,167.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,208.92
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$3,414.62
|
| Rate for Payer: First Health Commercial |
$3,908.30
|
| Rate for Payer: Humana Commercial |
$3,496.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,579.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,838.66
|
| Rate for Payer: PHCS Commercial |
$3,949.44
|
| Rate for Payer: United Healthcare All Payer |
$3,620.32
|
|
|
MRI BREAST C-+ W/CAD UNI
|
Facility
|
OP
|
$4,114.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,234.20 |
| Max. Negotiated Rate |
$3,949.44 |
| Rate for Payer: Aetna Commercial |
$3,167.78
|
| Rate for Payer: Anthem Medicaid |
$1,414.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,208.92
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$3,414.62
|
| Rate for Payer: First Health Commercial |
$3,908.30
|
| Rate for Payer: Humana Commercial |
$3,496.90
|
| Rate for Payer: Humana KY Medicaid |
$1,414.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,291.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,579.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,838.66
|
| Rate for Payer: PHCS Commercial |
$3,949.44
|
| Rate for Payer: United Healthcare All Payer |
$3,620.32
|
|
|
MRI BREAST C-+ W/CAD UNI
|
Professional
|
Both
|
$4,114.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$2,468.40 |
| Rate for Payer: Ambetter Exchange |
$307.80
|
| Rate for Payer: Anthem Medicaid |
$298.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$307.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$307.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$369.36
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna Commercial |
$621.53
|
| Rate for Payer: Humana Medicaid |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$307.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.32
|
| Rate for Payer: Molina Healthcare Passport |
$298.35
|
| Rate for Payer: Multiplan PHCS |
$2,468.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$400.14
|
| Rate for Payer: UHCCP Medicaid |
$1,439.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$307.80
|
|
|
MRI BREAST C-+ W/CAD UNI(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
610P0049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$621.53 |
| Rate for Payer: Ambetter Exchange |
$307.80
|
| Rate for Payer: Anthem Medicaid |
$298.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$307.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$307.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$369.36
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$621.53
|
| Rate for Payer: Humana Medicaid |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$307.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.32
|
| Rate for Payer: Molina Healthcare Passport |
$298.35
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$400.14
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$307.80
|
|
|
MRI BREAST C-+ W/CAD UNI(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
610T0049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,361.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.16
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRI BREAST C-+ W/CAD UNI(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
610T0049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,361.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.16
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRI CARDIAC W AND W/O CON
|
Facility
|
IP
|
$4,534.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
61000045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,360.20 |
| Max. Negotiated Rate |
$4,352.64 |
| Rate for Payer: Aetna Commercial |
$3,491.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,536.52
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cigna Commercial |
$3,763.22
|
| Rate for Payer: First Health Commercial |
$4,307.30
|
| Rate for Payer: Humana Commercial |
$3,853.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,346.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,360.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,944.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,128.46
|
| Rate for Payer: PHCS Commercial |
$4,352.64
|
| Rate for Payer: United Healthcare All Payer |
$3,989.92
|
|
|
MRI CARDIAC W AND W/O CON
|
Facility
|
OP
|
$4,534.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
61000045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,352.64 |
| Rate for Payer: Aetna Commercial |
$3,491.18
|
| Rate for Payer: Anthem Medicaid |
$1,559.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,536.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cigna Commercial |
$3,763.22
|
| Rate for Payer: First Health Commercial |
$4,307.30
|
| Rate for Payer: Humana Commercial |
$3,853.90
|
| Rate for Payer: Humana KY Medicaid |
$1,559.24
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,575.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,346.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,590.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,944.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,128.46
|
| Rate for Payer: PHCS Commercial |
$4,352.64
|
| Rate for Payer: United Healthcare All Payer |
$3,989.92
|
|
|
MRI CARDIAC W AND W/O CON
|
Professional
|
Both
|
$4,534.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
61000045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$167.36 |
| Max. Negotiated Rate |
$2,720.40 |
| Rate for Payer: Aetna Commercial |
$1,032.80
|
| Rate for Payer: Ambetter Exchange |
$331.34
|
| Rate for Payer: Anthem Medicaid |
$475.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$331.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$331.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$397.61
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cash Price |
$2,267.00
|
| Rate for Payer: Cigna Commercial |
$1,077.03
|
| Rate for Payer: Healthspan PPO |
$709.69
|
| Rate for Payer: Humana Medicaid |
$475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$331.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.09
|
| Rate for Payer: Molina Healthcare Passport |
$475.58
|
| Rate for Payer: Multiplan PHCS |
$2,720.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.74
|
| Rate for Payer: UHCCP Medicaid |
$1,586.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$331.34
|
|
|
MRI CARDIAC W AND W/O CON(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
610P0045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$1,077.03 |
| Rate for Payer: Aetna Commercial |
$1,032.80
|
| Rate for Payer: Ambetter Exchange |
$331.34
|
| Rate for Payer: Anthem Medicaid |
$475.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$331.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$331.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$397.61
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$1,077.03
|
| Rate for Payer: Healthspan PPO |
$709.69
|
| Rate for Payer: Humana Medicaid |
$475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$331.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.09
|
| Rate for Payer: Molina Healthcare Passport |
$475.58
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.74
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$331.34
|
|
|
MRI CARDIAC W AND W/O CON(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
610T0045
|
|
Hospital Revenue Code
|
610
|
| 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 CARDIAC W AND W/O CON(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
610T0045
|
|
Hospital Revenue Code
|
610
|
| 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 CARDIAC W/O CONTRAST
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
61000044
|
|
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 CARDIAC W/O CONTRAST
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
61000044
|
|
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 CARDIAC W/O CONTRAST
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$726.36
|
| Rate for Payer: Ambetter Exchange |
$255.36
|
| Rate for Payer: Anthem Medicaid |
$309.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$255.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$306.43
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$798.65
|
| Rate for Payer: Healthspan PPO |
$499.11
|
| Rate for Payer: Humana Medicaid |
$309.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$255.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.13
|
| Rate for Payer: Molina Healthcare Passport |
$309.93
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$331.97
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$255.36
|
|
|
MRI CARDIAC W/O CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
610P0044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$798.65 |
| Rate for Payer: Aetna Commercial |
$726.36
|
| Rate for Payer: Ambetter Exchange |
$255.36
|
| Rate for Payer: Anthem Medicaid |
$309.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$255.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$306.43
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$798.65
|
| Rate for Payer: Healthspan PPO |
$499.11
|
| Rate for Payer: Humana Medicaid |
$309.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$255.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.13
|
| Rate for Payer: Molina Healthcare Passport |
$309.93
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$331.97
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$255.36
|
|
|
MRI CARDIAC W/O CONTRAST(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
610T0044
|
|
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 CARDIAC W/O CONTRAST(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
610T0044
|
|
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
|
|
