|
MRI CROME HF QUAD IS4 DF4
|
Facility
|
OP
|
$80,800.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$24,240.00 |
| Max. Negotiated Rate |
$77,568.00 |
| Rate for Payer: Aetna Commercial |
$62,216.00
|
| Rate for Payer: Anthem Medicaid |
$27,787.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,024.00
|
| Rate for Payer: Cash Price |
$40,400.00
|
| Rate for Payer: Cigna Commercial |
$67,064.00
|
| Rate for Payer: First Health Commercial |
$76,760.00
|
| Rate for Payer: Humana Commercial |
$68,680.00
|
| Rate for Payer: Humana KY Medicaid |
$27,787.12
|
| Rate for Payer: Kentucky WC Medicaid |
$28,069.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,256.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,630.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,344.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,104.00
|
| Rate for Payer: Ohio Health Group HMO |
$60,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,296.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,752.00
|
| Rate for Payer: PHCS Commercial |
$77,568.00
|
| Rate for Payer: United Healthcare All Payer |
$71,104.00
|
|
|
MRI FACE WITH CONTRAST
|
Facility
|
OP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,717.12 |
| Rate for Payer: Aetna Commercial |
$2,981.44
|
| Rate for Payer: Anthem Medicaid |
$1,331.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,020.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$3,213.76
|
| Rate for Payer: First Health Commercial |
$3,678.40
|
| Rate for Payer: Humana Commercial |
$3,291.20
|
| Rate for Payer: Humana KY Medicaid |
$1,331.58
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,345.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,175.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,857.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,358.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,407.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,904.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,368.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.68
|
| Rate for Payer: PHCS Commercial |
$3,717.12
|
| Rate for Payer: United Healthcare All Payer |
$3,407.36
|
|
|
MRI FACE WITH CONTRAST
|
Facility
|
IP
|
$3,872.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$3,717.12 |
| Rate for Payer: Aetna Commercial |
$2,981.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,020.16
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$3,213.76
|
| Rate for Payer: First Health Commercial |
$3,678.40
|
| Rate for Payer: Humana Commercial |
$3,291.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,175.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,857.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,407.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,904.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,368.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.68
|
| Rate for Payer: PHCS Commercial |
$3,717.12
|
| Rate for Payer: United Healthcare All Payer |
$3,407.36
|
|
|
MRI FACE WITH CONTRAST
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
61000003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$2,323.20 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Ambetter Exchange |
$244.63
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$244.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$244.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$293.56
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cigna Commercial |
$893.77
|
| Rate for Payer: Healthspan PPO |
$529.79
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$244.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$2,323.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$318.02
|
| Rate for Payer: UHCCP Medicaid |
$1,355.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$244.63
|
|
|
MRI FACE WITH CONTRAST(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
610P0003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$893.77 |
| Rate for Payer: Aetna Commercial |
$771.00
|
| Rate for Payer: Ambetter Exchange |
$244.63
|
| Rate for Payer: Anthem Medicaid |
$399.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$244.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$244.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$293.56
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$893.77
|
| Rate for Payer: Healthspan PPO |
$529.79
|
| Rate for Payer: Humana Medicaid |
$399.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$244.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.59
|
| Rate for Payer: Molina Healthcare Passport |
$399.60
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$318.02
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$244.63
|
|
|
MRI FACE WITH CONTRAST(T
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
610T0003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,071.60 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,857.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,107.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,464.68
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
MRI FACE WITH CONTRAST(T
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 70542
|
| Hospital Charge Code |
610T0003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem Medicaid |
$1,228.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Humana KY Medicaid |
$1,228.41
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,857.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,107.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,464.68
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
MRI FACE WO CONTRAST
|
Facility
|
IP
|
$3,778.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,133.40 |
| Max. Negotiated Rate |
$3,626.88 |
| Rate for Payer: Aetna Commercial |
$2,909.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.84
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cigna Commercial |
$3,135.74
|
| Rate for Payer: First Health Commercial |
$3,589.10
|
| Rate for Payer: Humana Commercial |
$3,211.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,788.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.82
|
| Rate for Payer: PHCS Commercial |
$3,626.88
|
| Rate for Payer: United Healthcare All Payer |
$3,324.64
|
|
|
MRI FACE WO CONTRAST
|
Facility
|
OP
|
$3,778.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,626.88 |
| Rate for Payer: Aetna Commercial |
$2,909.06
|
| Rate for Payer: Anthem Medicaid |
$1,299.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cigna Commercial |
$3,135.74
|
| Rate for Payer: First Health Commercial |
$3,589.10
|
| Rate for Payer: Humana Commercial |
$3,211.30
|
| Rate for Payer: Humana KY Medicaid |
$1,299.25
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,788.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,325.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.82
|
| Rate for Payer: PHCS Commercial |
$3,626.88
|
| Rate for Payer: United Healthcare All Payer |
$3,324.64
|
|
|
MRI FACE WO CONTRAST
|
Professional
|
Both
|
$3,778.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
61000002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$2,266.80 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Ambetter Exchange |
$206.64
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$206.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$206.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.97
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cash Price |
$1,889.00
|
| Rate for Payer: Cigna Commercial |
$764.72
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,266.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$268.63
|
| Rate for Payer: UHCCP Medicaid |
$1,322.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$206.64
|
|
|
MRI FACE WO CONTRAST(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
610P0002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$764.72 |
| Rate for Payer: Aetna Commercial |
$629.84
|
| Rate for Payer: Ambetter Exchange |
$206.64
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$206.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$206.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.97
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$764.72
|
| Rate for Payer: Healthspan PPO |
$432.80
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.64
|
| 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 |
$268.63
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$206.64
|
|
|
MRI FACE WO CONTRAST(T
|
Facility
|
IP
|
$3,528.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
610T0002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,058.40 |
| Max. Negotiated Rate |
$3,386.88 |
| Rate for Payer: Aetna Commercial |
$2,716.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,751.84
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$2,928.24
|
| Rate for Payer: First Health Commercial |
$3,351.60
|
| Rate for Payer: Humana Commercial |
$2,998.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,603.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,104.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,822.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,069.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,434.32
|
| Rate for Payer: PHCS Commercial |
$3,386.88
|
| Rate for Payer: United Healthcare All Payer |
$3,104.64
|
|
|
MRI FACE WO CONTRAST(T
|
Facility
|
OP
|
$3,528.00
|
|
|
Service Code
|
HCPCS 70540
|
| Hospital Charge Code |
610T0002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,386.88 |
| Rate for Payer: Aetna Commercial |
$2,716.56
|
| Rate for Payer: Anthem Medicaid |
$1,213.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,751.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$2,928.24
|
| Rate for Payer: First Health Commercial |
$3,351.60
|
| Rate for Payer: Humana Commercial |
$2,998.80
|
| Rate for Payer: Humana KY Medicaid |
$1,213.28
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,225.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,603.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,237.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,104.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,822.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,069.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,434.32
|
| Rate for Payer: PHCS Commercial |
$3,386.88
|
| Rate for Payer: United Healthcare All Payer |
$3,104.64
|
|
|
MRI FACE W WO CONTRAST
|
Facility
|
IP
|
$4,484.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,345.20 |
| Max. Negotiated Rate |
$4,304.64 |
| Rate for Payer: Aetna Commercial |
$3,452.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,497.52
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cigna Commercial |
$3,721.72
|
| Rate for Payer: First Health Commercial |
$4,259.80
|
| Rate for Payer: Humana Commercial |
$3,811.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,676.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,345.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,945.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,901.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,093.96
|
| Rate for Payer: PHCS Commercial |
$4,304.64
|
| Rate for Payer: United Healthcare All Payer |
$3,945.92
|
|
|
MRI FACE W WO CONTRAST
|
Facility
|
OP
|
$4,484.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,304.64 |
| Rate for Payer: Aetna Commercial |
$3,452.68
|
| Rate for Payer: Anthem Medicaid |
$1,542.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,497.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cigna Commercial |
$3,721.72
|
| Rate for Payer: First Health Commercial |
$4,259.80
|
| Rate for Payer: Humana Commercial |
$3,811.40
|
| Rate for Payer: Humana KY Medicaid |
$1,542.05
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,557.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,676.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,945.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,901.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,093.96
|
| Rate for Payer: PHCS Commercial |
$4,304.64
|
| Rate for Payer: United Healthcare All Payer |
$3,945.92
|
|
|
MRI FACE W WO CONTRAST
|
Professional
|
Both
|
$4,484.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
61000004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$135.88 |
| Max. Negotiated Rate |
$2,690.40 |
| Rate for Payer: Aetna Commercial |
$983.53
|
| Rate for Payer: Ambetter Exchange |
$310.59
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.71
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cash Price |
$2,242.00
|
| Rate for Payer: Cigna Commercial |
$1,471.34
|
| Rate for Payer: Healthspan PPO |
$675.83
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$2,690.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.77
|
| Rate for Payer: UHCCP Medicaid |
$1,569.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.59
|
|
|
MRI FACE W WO CONTRAST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
610P0004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,471.34 |
| Rate for Payer: Aetna Commercial |
$983.53
|
| Rate for Payer: Ambetter Exchange |
$310.59
|
| Rate for Payer: Anthem Medicaid |
$716.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.71
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$1,471.34
|
| Rate for Payer: Healthspan PPO |
$675.83
|
| Rate for Payer: Humana Medicaid |
$716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.00
|
| Rate for Payer: Molina Healthcare Passport |
$716.67
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.77
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.59
|
|
|
MRI FACE W WO CONTRAST(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
610T0004
|
|
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 FACE W WO CONTRAST(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 70543
|
| Hospital Charge Code |
610T0004
|
|
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 ICD COBALT DDPA2D4
|
Facility
|
OP
|
$39,945.76
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,983.73 |
| Max. Negotiated Rate |
$38,347.93 |
| Rate for Payer: Aetna Commercial |
$30,758.24
|
| Rate for Payer: Anthem Medicaid |
$13,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,157.69
|
| Rate for Payer: Cash Price |
$19,972.88
|
| Rate for Payer: Cigna Commercial |
$33,154.98
|
| Rate for Payer: First Health Commercial |
$37,948.47
|
| Rate for Payer: Humana Commercial |
$33,953.90
|
| Rate for Payer: Humana KY Medicaid |
$13,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$13,877.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,755.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,479.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,983.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,012.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,152.27
|
| Rate for Payer: Ohio Health Group HMO |
$29,959.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,956.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,752.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,562.57
|
| Rate for Payer: PHCS Commercial |
$38,347.93
|
| Rate for Payer: United Healthcare All Payer |
$35,152.27
|
|
|
MRI ICD COBALT DDPA2D4
|
Facility
|
IP
|
$39,945.76
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,983.73 |
| Max. Negotiated Rate |
$38,347.93 |
| Rate for Payer: Aetna Commercial |
$30,758.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,157.69
|
| Rate for Payer: Cash Price |
$19,972.88
|
| Rate for Payer: Cigna Commercial |
$33,154.98
|
| Rate for Payer: First Health Commercial |
$37,948.47
|
| Rate for Payer: Humana Commercial |
$33,953.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,755.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,479.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,983.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,152.27
|
| Rate for Payer: Ohio Health Group HMO |
$29,959.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,956.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,752.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,562.57
|
| Rate for Payer: PHCS Commercial |
$38,347.93
|
| Rate for Payer: United Healthcare All Payer |
$35,152.27
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
IP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
61000037
|
|
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 JNT OF LWR EXTRE W/O DYE
|
Facility
|
OP
|
$3,902.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
61000037
|
|
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 JNT OF LWR EXTRE W/O DYE
|
Professional
|
Both
|
$3,902.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
61000037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$2,341.20 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Ambetter Exchange |
$186.65
|
| Rate for Payer: Anthem Medicaid |
$344.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$223.98
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cash Price |
$1,951.00
|
| Rate for Payer: Cigna Commercial |
$761.42
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$344.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.67
|
| Rate for Payer: Molina Healthcare Passport |
$344.77
|
| Rate for Payer: Multiplan PHCS |
$2,341.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$242.65
|
| Rate for Payer: UHCCP Medicaid |
$1,365.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.65
|
|
|
MRI JNT OF LWR EXTRE W/O DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73721
|
| Hospital Charge Code |
610P0037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$761.42 |
| Rate for Payer: Aetna Commercial |
$630.02
|
| Rate for Payer: Ambetter Exchange |
$186.65
|
| Rate for Payer: Anthem Medicaid |
$344.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$223.98
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$761.42
|
| Rate for Payer: Healthspan PPO |
$432.92
|
| Rate for Payer: Humana Medicaid |
$344.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.67
|
| Rate for Payer: Molina Healthcare Passport |
$344.77
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$242.65
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$348.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.65
|
|
