|
GAIT TR INC STAIRS - 15 MIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 97116
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
GALACTOSE-ALPHA-1 3-GALCT IGE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 86008
|
| Hospital Charge Code |
30001798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
GALACTOSE-ALPHA-1 3-GALCT IGE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 86008
|
| Hospital Charge Code |
30001798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Kentucky WC Medicaid |
$18.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
GALAFLEX SLING INSERT (BILAT)
|
Professional
|
Both
|
$780.00
|
|
| Hospital Charge Code |
22200200
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
|
|
GALAFLEX SLING INSERT (UNILAT)
|
Professional
|
Both
|
$390.00
|
|
| Hospital Charge Code |
22200199
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
|
|
GALAFLEX SLING INSRT(BILAT)-80
|
Professional
|
Both
|
$390.00
|
|
| Hospital Charge Code |
22200392
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
|
|
GALAFLEX SLING INSRT(UNILA)-80
|
Professional
|
Both
|
$195.00
|
|
| Hospital Charge Code |
22200391
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Multiplan PHCS |
$117.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$136.50
|
| Rate for Payer: UHCCP Medicaid |
$68.25
|
|
|
GALLIUM 68 NETSPOT
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
HCPCS A9587
|
| Hospital Charge Code |
34000072
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$2,995.20 |
| Rate for Payer: Aetna Commercial |
$2,402.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,433.60
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cigna Commercial |
$2,589.60
|
| Rate for Payer: First Health Commercial |
$2,964.00
|
| Rate for Payer: Humana Commercial |
$2,652.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,558.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,302.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,745.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,714.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,152.80
|
| Rate for Payer: PHCS Commercial |
$2,995.20
|
| Rate for Payer: United Healthcare All Payer |
$2,745.60
|
|
|
GALLIUM 68 NETSPOT
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
HCPCS A9587
|
| Hospital Charge Code |
34000072
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$51.09 |
| Max. Negotiated Rate |
$2,995.20 |
| Rate for Payer: Aetna Commercial |
$2,402.40
|
| Rate for Payer: Anthem Medicaid |
$1,072.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,433.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.97
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cigna Commercial |
$2,589.60
|
| Rate for Payer: First Health Commercial |
$2,964.00
|
| Rate for Payer: Humana Commercial |
$2,652.00
|
| Rate for Payer: Humana KY Medicaid |
$1,072.97
|
| Rate for Payer: Humana Medicare Advantage |
$51.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,083.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,558.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,302.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,745.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,714.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,152.80
|
| Rate for Payer: PHCS Commercial |
$2,995.20
|
| Rate for Payer: United Healthcare All Payer |
$2,745.60
|
|
|
GALLIUM GA 67 PER MCI
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34000063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem Medicaid |
$152.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Humana KY Medicaid |
$152.00
|
| Rate for Payer: Kentucky WC Medicaid |
$153.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.98
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
GALLIUM GA 67 PER MCI
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34000063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.98
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
GALLIUM GA 67 PER MCI
|
Professional
|
Both
|
$442.00
|
|
| Hospital Charge Code |
34000063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Multiplan PHCS |
$265.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.40
|
| Rate for Payer: UHCCP Medicaid |
$154.70
|
|
|
GALLIUM GA 67 PER MCI(T
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
340T0063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem Medicaid |
$152.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Humana KY Medicaid |
$152.00
|
| Rate for Payer: Kentucky WC Medicaid |
$153.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.98
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
GALLIUM GA 67 PER MCI(T
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
340T0063
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.98
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
GALLIUM ILLUCCIX 1 MCI (5 MCI)
|
Facility
|
IP
|
$5,316.00
|
|
|
Service Code
|
HCPCS A9596
|
| Hospital Charge Code |
34000123
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,594.80 |
| Max. Negotiated Rate |
$5,103.36 |
| Rate for Payer: Aetna Commercial |
$4,093.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,146.48
|
| Rate for Payer: Cash Price |
$2,658.00
|
| Rate for Payer: Cigna Commercial |
$4,412.28
|
| Rate for Payer: First Health Commercial |
$5,050.20
|
| Rate for Payer: Humana Commercial |
$4,518.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,359.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,923.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,678.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,987.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,252.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,624.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,668.04
|
| Rate for Payer: PHCS Commercial |
$5,103.36
|
| Rate for Payer: United Healthcare All Payer |
$4,678.08
|
|
|
GALLIUM ILLUCCIX 1 MCI (5 MCI)
|
Facility
|
OP
|
$5,316.00
|
|
|
Service Code
|
HCPCS A9596
|
| Hospital Charge Code |
34000123
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$511.55 |
| Max. Negotiated Rate |
$5,103.36 |
| Rate for Payer: Aetna Commercial |
$4,093.32
|
| Rate for Payer: Anthem Medicaid |
$1,828.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$511.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,146.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$716.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$690.59
|
| Rate for Payer: Cash Price |
$2,658.00
|
| Rate for Payer: Cash Price |
$2,658.00
|
| Rate for Payer: Cigna Commercial |
$4,412.28
|
| Rate for Payer: First Health Commercial |
$5,050.20
|
| Rate for Payer: Humana Commercial |
$4,518.60
|
| Rate for Payer: Humana KY Medicaid |
$1,828.17
|
| Rate for Payer: Humana Medicare Advantage |
$511.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,846.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,359.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,923.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,864.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,678.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,987.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,252.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,624.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,668.04
|
| Rate for Payer: PHCS Commercial |
$5,103.36
|
| Rate for Payer: United Healthcare All Payer |
$4,678.08
|
|
|
GALLIUM ILLUCCIX EACH ADD MCI
|
Facility
|
IP
|
$1,033.20
|
|
|
Service Code
|
HCPCS A9596
|
| Hospital Charge Code |
34000124
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$309.96 |
| Max. Negotiated Rate |
$991.87 |
| Rate for Payer: Aetna Commercial |
$795.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$805.90
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$857.56
|
| Rate for Payer: First Health Commercial |
$981.54
|
| Rate for Payer: Humana Commercial |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$847.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$762.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$909.22
|
| Rate for Payer: Ohio Health Group HMO |
$774.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$712.91
|
| Rate for Payer: PHCS Commercial |
$991.87
|
| Rate for Payer: United Healthcare All Payer |
$909.22
|
|
|
GALLIUM ILLUCCIX EACH ADD MCI
|
Facility
|
OP
|
$1,033.20
|
|
|
Service Code
|
HCPCS A9596
|
| Hospital Charge Code |
34000124
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$355.32 |
| Max. Negotiated Rate |
$991.87 |
| Rate for Payer: Aetna Commercial |
$795.56
|
| Rate for Payer: Anthem Medicaid |
$355.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$511.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$805.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$716.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$690.59
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$857.56
|
| Rate for Payer: First Health Commercial |
$981.54
|
| Rate for Payer: Humana Commercial |
$878.22
|
| Rate for Payer: Humana KY Medicaid |
$355.32
|
| Rate for Payer: Humana Medicare Advantage |
$511.55
|
| Rate for Payer: Kentucky WC Medicaid |
$358.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$847.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$762.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$362.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$909.22
|
| Rate for Payer: Ohio Health Group HMO |
$774.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$826.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$712.91
|
| Rate for Payer: PHCS Commercial |
$991.87
|
| Rate for Payer: United Healthcare All Payer |
$909.22
|
|
|
GALLIUM SCAN WHOLE BODY
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
34000035
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$1,782.72 |
| Rate for Payer: Aetna Commercial |
$1,429.89
|
| Rate for Payer: Anthem Medicaid |
$638.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$928.50
|
| Rate for Payer: Cash Price |
$928.50
|
| Rate for Payer: Cigna Commercial |
$1,541.31
|
| Rate for Payer: First Health Commercial |
$1,764.15
|
| Rate for Payer: Humana Commercial |
$1,578.45
|
| Rate for Payer: Humana KY Medicaid |
$638.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$645.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,522.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,392.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,281.33
|
| Rate for Payer: PHCS Commercial |
$1,782.72
|
| Rate for Payer: United Healthcare All Payer |
$1,634.16
|
|
|
GALLIUM SCAN WHOLE BODY
|
Facility
|
IP
|
$1,857.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
34000035
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.10 |
| Max. Negotiated Rate |
$1,782.72 |
| Rate for Payer: Aetna Commercial |
$1,429.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.46
|
| Rate for Payer: Cash Price |
$928.50
|
| Rate for Payer: Cigna Commercial |
$1,541.31
|
| Rate for Payer: First Health Commercial |
$1,764.15
|
| Rate for Payer: Humana Commercial |
$1,578.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,522.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,392.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,281.33
|
| Rate for Payer: PHCS Commercial |
$1,782.72
|
| Rate for Payer: United Healthcare All Payer |
$1,634.16
|
|
|
GALLIUM SCAN WHOLE BODY
|
Professional
|
Both
|
$1,857.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
34000035
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Aetna Commercial |
$479.00
|
| Rate for Payer: Ambetter Exchange |
$245.73
|
| Rate for Payer: Anthem Medicaid |
$234.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$245.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$294.88
|
| Rate for Payer: Cash Price |
$928.50
|
| Rate for Payer: Cash Price |
$928.50
|
| Rate for Payer: Cigna Commercial |
$411.57
|
| Rate for Payer: Healthspan PPO |
$478.75
|
| Rate for Payer: Humana Medicaid |
$234.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$245.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.84
|
| Rate for Payer: Molina Healthcare Passport |
$234.16
|
| Rate for Payer: Multiplan PHCS |
$1,114.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$319.45
|
| Rate for Payer: UHCCP Medicaid |
$649.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$236.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$245.73
|
|
|
GALLIUM SCAN WHOLE BODY(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
340P0035
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$479.00 |
| Rate for Payer: Aetna Commercial |
$479.00
|
| Rate for Payer: Ambetter Exchange |
$245.73
|
| Rate for Payer: Anthem Medicaid |
$234.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$245.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$294.88
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$411.57
|
| Rate for Payer: Healthspan PPO |
$478.75
|
| Rate for Payer: Humana Medicaid |
$234.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$245.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.84
|
| Rate for Payer: Molina Healthcare Passport |
$234.16
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$319.45
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$236.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$245.73
|
|
|
GALLIUM SCAN WHOLE BODY(T
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
340T0035
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$504.60 |
| Max. Negotiated Rate |
$1,614.72 |
| Rate for Payer: Aetna Commercial |
$1,295.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.96
|
| Rate for Payer: Cash Price |
$841.00
|
| Rate for Payer: Cigna Commercial |
$1,396.06
|
| Rate for Payer: First Health Commercial |
$1,597.90
|
| Rate for Payer: Humana Commercial |
$1,429.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.58
|
| Rate for Payer: PHCS Commercial |
$1,614.72
|
| Rate for Payer: United Healthcare All Payer |
$1,480.16
|
|
|
GALLIUM SCAN WHOLE BODY(T
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
340T0035
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$578.44 |
| Max. Negotiated Rate |
$1,688.74 |
| Rate for Payer: Aetna Commercial |
$1,295.14
|
| Rate for Payer: Anthem Medicaid |
$578.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$841.00
|
| Rate for Payer: Cash Price |
$841.00
|
| Rate for Payer: Cigna Commercial |
$1,396.06
|
| Rate for Payer: First Health Commercial |
$1,597.90
|
| Rate for Payer: Humana Commercial |
$1,429.70
|
| Rate for Payer: Humana KY Medicaid |
$578.44
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$584.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.58
|
| Rate for Payer: PHCS Commercial |
$1,614.72
|
| Rate for Payer: United Healthcare All Payer |
$1,480.16
|
|
|
GAMASTAN 1ML (10ML SDV)
|
Facility
|
OP
|
$1,055.39
|
|
|
Service Code
|
HCPCS J1560
|
| Hospital Charge Code |
25002086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$1,013.17 |
| Rate for Payer: Aetna Commercial |
$812.65
|
| Rate for Payer: Anthem Medicaid |
$362.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$167.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$823.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$233.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.53
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$875.97
|
| Rate for Payer: First Health Commercial |
$1,002.62
|
| Rate for Payer: Humana Commercial |
$897.08
|
| Rate for Payer: Humana KY Medicaid |
$362.95
|
| Rate for Payer: Humana Medicare Advantage |
$167.06
|
| Rate for Payer: Kentucky WC Medicaid |
$366.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$778.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$928.74
|
| Rate for Payer: Ohio Health Group HMO |
$791.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$918.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.22
|
| Rate for Payer: PHCS Commercial |
$1,013.17
|
| Rate for Payer: United Healthcare All Payer |
$928.74
|
|
