|
RADIATION 5 TREATMENTS
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 77427
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.64 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$297.98
|
| Rate for Payer: Anthem Medicaid |
$130.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$269.65
|
| Rate for Payer: Healthspan PPO |
$251.29
|
| Rate for Payer: Humana Medicaid |
$130.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.25
|
| Rate for Payer: Molina Healthcare Passport |
$130.64
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.95
|
|
|
RADIATION 5 TREATMENTS(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 77427
|
| Hospital Charge Code |
333P0037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.64 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$297.98
|
| Rate for Payer: Anthem Medicaid |
$130.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$269.65
|
| Rate for Payer: Healthspan PPO |
$251.29
|
| Rate for Payer: Humana Medicaid |
$130.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.25
|
| Rate for Payer: Molina Healthcare Passport |
$130.64
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.95
|
|
|
RADIATION THERAPY COMPL 1-2
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 77431
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
RADIATION THERAPY COMPL 1-2
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 77431
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
RADIATION THPY PLANNING
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.66
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
RADIATION THPY PLANNING
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.66
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
RADIATION THPY PLANNING
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$169.25
|
| Rate for Payer: Anthem Medicaid |
$90.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$159.21
|
| Rate for Payer: Healthspan PPO |
$142.74
|
| Rate for Payer: Humana Medicaid |
$90.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.34
|
| Rate for Payer: Molina Healthcare Passport |
$90.53
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.44
|
|
|
RADIATION THPY PLANNING
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RADIATION THPY PLANNING
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$453.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$459.42
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: First Health Commercial |
$559.55
|
| Rate for Payer: Humana Commercial |
$500.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$518.32
|
| Rate for Payer: Ohio Health Group HMO |
$441.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.59
|
| Rate for Payer: PHCS Commercial |
$565.44
|
| Rate for Payer: United Healthcare All Payer |
$518.32
|
|
|
RADIATION THPY PLANNING
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$1,286.00 |
| Rate for Payer: Aetna Commercial |
$251.01
|
| Rate for Payer: Anthem Medicaid |
$134.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,286.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$236.20
|
| Rate for Payer: Healthspan PPO |
$211.68
|
| Rate for Payer: Humana Medicaid |
$134.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.24
|
| Rate for Payer: Molina Healthcare Passport |
$134.55
|
| Rate for Payer: Multiplan PHCS |
$771.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.20
|
| Rate for Payer: UHCCP Medicaid |
$450.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.90
|
|
|
RADIATION THPY PLANNING
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$112.52
|
| Rate for Payer: Anthem Medicaid |
$59.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$589.00
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$105.88
|
| Rate for Payer: Healthspan PPO |
$94.89
|
| Rate for Payer: Humana Medicaid |
$59.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.79
|
| Rate for Payer: Molina Healthcare Passport |
$59.60
|
| Rate for Payer: Multiplan PHCS |
$353.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$412.30
|
| Rate for Payer: UHCCP Medicaid |
$206.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.20
|
|
|
RADIATION THPY PLANNING
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RADIATION THPY PLANNING
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$453.53
|
| Rate for Payer: Anthem Medicaid |
$202.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$459.42
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: First Health Commercial |
$559.55
|
| Rate for Payer: Humana Commercial |
$500.65
|
| Rate for Payer: Humana KY Medicaid |
$202.56
|
| Rate for Payer: Kentucky WC Medicaid |
$204.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$518.32
|
| Rate for Payer: Ohio Health Group HMO |
$441.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.59
|
| Rate for Payer: PHCS Commercial |
$565.44
|
| Rate for Payer: United Healthcare All Payer |
$518.32
|
|
|
RADIATION THPY PLANNING(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
333P0036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$251.01
|
| Rate for Payer: Anthem Medicaid |
$134.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$236.20
|
| Rate for Payer: Healthspan PPO |
$211.68
|
| Rate for Payer: Humana Medicaid |
$134.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.24
|
| Rate for Payer: Molina Healthcare Passport |
$134.55
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.90
|
|
|
RADIATION THPY PLANNING(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
333P0035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$169.25
|
| Rate for Payer: Anthem Medicaid |
$90.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$159.21
|
| Rate for Payer: Healthspan PPO |
$142.74
|
| Rate for Payer: Humana Medicaid |
$90.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.34
|
| Rate for Payer: Molina Healthcare Passport |
$90.53
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.44
|
|
|
RADIATION THPY PLANNING(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
333P0034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$112.52
|
| Rate for Payer: Anthem Medicaid |
$59.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$105.88
|
| Rate for Payer: Healthspan PPO |
$94.89
|
| Rate for Payer: Humana Medicaid |
$59.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.79
|
| Rate for Payer: Molina Healthcare Passport |
$59.60
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.20
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
333T0036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem Medicaid |
$287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Humana KY Medicaid |
$287.50
|
| Rate for Payer: Kentucky WC Medicaid |
$290.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.16
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
333T0036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.16
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
333T0034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$225.42
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$239.87
|
| Rate for Payer: First Health Commercial |
$274.55
|
| Rate for Payer: Humana Commercial |
$245.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$213.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$254.32
|
| Rate for Payer: Ohio Health Group HMO |
$216.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.59
|
| Rate for Payer: PHCS Commercial |
$277.44
|
| Rate for Payer: United Healthcare All Payer |
$254.32
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
333T0034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Anthem Medicaid |
$99.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$225.42
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$239.87
|
| Rate for Payer: First Health Commercial |
$274.55
|
| Rate for Payer: Humana Commercial |
$245.65
|
| Rate for Payer: Humana KY Medicaid |
$99.39
|
| Rate for Payer: Kentucky WC Medicaid |
$100.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$213.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$254.32
|
| Rate for Payer: Ohio Health Group HMO |
$216.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.59
|
| Rate for Payer: PHCS Commercial |
$277.44
|
| Rate for Payer: United Healthcare All Payer |
$254.32
|
|
|
RADIATION TREAT AID
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$562.00 |
| Rate for Payer: Aetna Commercial |
$119.65
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$562.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$118.98
|
| Rate for Payer: Healthspan PPO |
$100.90
|
| Rate for Payer: Humana Medicaid |
$59.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.00
|
| Rate for Payer: Molina Healthcare Passport |
$59.80
|
| Rate for Payer: Multiplan PHCS |
$337.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.40
|
| Rate for Payer: UHCCP Medicaid |
$196.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.40
|
|
|
RADIATION TREAT AID
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem Medicaid |
$193.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Humana KY Medicaid |
$193.27
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$195.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.22
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
RADIATION TREAT AID
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$823.68 |
| Rate for Payer: Aetna Commercial |
$660.66
|
| Rate for Payer: Anthem Medicaid |
$295.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$669.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$712.14
|
| Rate for Payer: First Health Commercial |
$815.10
|
| Rate for Payer: Humana Commercial |
$729.30
|
| Rate for Payer: Humana KY Medicaid |
$295.07
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$298.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$703.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$300.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.04
|
| Rate for Payer: Ohio Health Group HMO |
$643.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.98
|
| Rate for Payer: PHCS Commercial |
$823.68
|
| Rate for Payer: United Healthcare All Payer |
$755.04
|
|
|
RADIATION TREAT AID
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$111.54 |
| Max. Negotiated Rate |
$823.68 |
| Rate for Payer: Aetna Commercial |
$660.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$669.24
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$712.14
|
| Rate for Payer: First Health Commercial |
$815.10
|
| Rate for Payer: Humana Commercial |
$729.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$703.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.04
|
| Rate for Payer: Ohio Health Group HMO |
$643.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.98
|
| Rate for Payer: PHCS Commercial |
$823.68
|
| Rate for Payer: United Healthcare All Payer |
$755.04
|
|
|
RADIATION TREAT AID
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.22
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
