|
RADICAL RESECTION OF STERNUM(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 21632
|
| Hospital Charge Code |
761P0404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.16 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$1,861.56
|
| Rate for Payer: Anthem Medicaid |
$851.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$2,010.57
|
| Rate for Payer: Healthspan PPO |
$1,686.18
|
| Rate for Payer: Humana Medicaid |
$851.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,607.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.18
|
| Rate for Payer: Molina Healthcare Passport |
$851.16
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$859.67
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 21558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
RADICAL RESECT OF TUMOR
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,165.84 |
| Max. Negotiated Rate |
$8,609.28 |
| Rate for Payer: Aetna Commercial |
$6,905.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.04
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cigna Commercial |
$7,443.44
|
| Rate for Payer: First Health Commercial |
$8,519.60
|
| Rate for Payer: Humana Commercial |
$7,622.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,353.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,690.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,891.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.08
|
| Rate for Payer: PHCS Commercial |
$8,609.28
|
| Rate for Payer: United Healthcare All Payer |
$7,891.84
|
|
|
RADICAL RESECT OF TUMOR
|
Professional
|
Both
|
$8,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.93 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Aetna Commercial |
$616.59
|
| Rate for Payer: Anthem Medicaid |
$341.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,968.00
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cigna Commercial |
$682.89
|
| Rate for Payer: Healthspan PPO |
$558.50
|
| Rate for Payer: Humana Medicaid |
$341.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.77
|
| Rate for Payer: Molina Healthcare Passport |
$341.93
|
| Rate for Payer: Multiplan PHCS |
$5,380.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,277.60
|
| Rate for Payer: UHCCP Medicaid |
$3,138.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.35
|
|
|
RADICAL RESECT OF TUMOR
|
Facility
|
OP
|
$8,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,165.84 |
| Max. Negotiated Rate |
$8,609.28 |
| Rate for Payer: Aetna Commercial |
$6,905.36
|
| Rate for Payer: Anthem Medicaid |
$3,084.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,995.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cash Price |
$4,484.00
|
| Rate for Payer: Cigna Commercial |
$7,443.44
|
| Rate for Payer: First Health Commercial |
$8,519.60
|
| Rate for Payer: Humana Commercial |
$7,622.80
|
| Rate for Payer: Humana KY Medicaid |
$3,084.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,115.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,353.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,618.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,145.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,891.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,726.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,793.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,165.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.08
|
| Rate for Payer: PHCS Commercial |
$8,609.28
|
| Rate for Payer: United Healthcare All Payer |
$7,891.84
|
|
|
RADICAL RESECT OF TUMOR(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
761P0366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.93 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$616.59
|
| Rate for Payer: Anthem Medicaid |
$341.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$682.89
|
| Rate for Payer: Healthspan PPO |
$558.50
|
| Rate for Payer: Humana Medicaid |
$341.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.77
|
| Rate for Payer: Molina Healthcare Passport |
$341.93
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.35
|
|
|
RADICAL RESECT OF TUMOR(T
|
Facility
|
OP
|
$7,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
761T0366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,035.84 |
| Max. Negotiated Rate |
$7,649.28 |
| Rate for Payer: Aetna Commercial |
$6,135.36
|
| Rate for Payer: Anthem Medicaid |
$2,740.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,215.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cigna Commercial |
$6,613.44
|
| Rate for Payer: First Health Commercial |
$7,569.60
|
| Rate for Payer: Humana Commercial |
$6,772.80
|
| Rate for Payer: Humana KY Medicaid |
$2,740.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,768.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,533.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,880.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,795.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,011.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,470.08
|
| Rate for Payer: PHCS Commercial |
$7,649.28
|
| Rate for Payer: United Healthcare All Payer |
$7,011.84
|
|
|
RADICAL RESECT OF TUMOR(T
|
Facility
|
IP
|
$7,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
761T0366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,035.84 |
| Max. Negotiated Rate |
$7,649.28 |
| Rate for Payer: Aetna Commercial |
$6,135.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,215.04
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cigna Commercial |
$6,613.44
|
| Rate for Payer: First Health Commercial |
$7,569.60
|
| Rate for Payer: Humana Commercial |
$6,772.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,533.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,880.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,390.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,011.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,470.08
|
| Rate for Payer: PHCS Commercial |
$7,649.28
|
| Rate for Payer: United Healthcare All Payer |
$7,011.84
|
|
|
RADICAL RESECT TUMOR CLAVICLE
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem Medicaid |
$1,134.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Humana KY Medicaid |
$1,134.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
RADICAL RESECT TUMOR CLAVICLE
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
RADICAL RESECT TUMOR CLAVICLE
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Aetna Commercial |
$1,303.66
|
| Rate for Payer: Anthem Medicaid |
$600.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,300.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$1,410.67
|
| Rate for Payer: Healthspan PPO |
$1,180.84
|
| Rate for Payer: Humana Medicaid |
$600.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,774.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.84
|
| Rate for Payer: Molina Healthcare Passport |
$600.82
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,310.00
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.83
|
|
|
RADICAL RESECT TUMOR CLAVICL(P
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
761P0451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Aetna Commercial |
$1,303.66
|
| Rate for Payer: Anthem Medicaid |
$600.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,300.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$1,410.67
|
| Rate for Payer: Healthspan PPO |
$1,180.84
|
| Rate for Payer: Humana Medicaid |
$600.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,774.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.84
|
| Rate for Payer: Molina Healthcare Passport |
$600.82
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,310.00
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.83
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$853.14 |
| Max. Negotiated Rate |
$6,300.14 |
| Rate for Payer: Aetna Commercial |
$5,053.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cigna Commercial |
$5,447.00
|
| Rate for Payer: First Health Commercial |
$6,234.52
|
| Rate for Payer: Humana Commercial |
$5,578.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.13
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.42
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$544.23 |
| Max. Negotiated Rate |
$4,018.92 |
| Rate for Payer: Aetna Commercial |
$3,223.51
|
| Rate for Payer: Anthem Medicaid |
$1,439.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$620.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,265.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$868.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.01
|
| Rate for Payer: Cash Price |
$2,093.19
|
| Rate for Payer: Cash Price |
$2,093.19
|
| Rate for Payer: Cigna Commercial |
$3,474.70
|
| Rate for Payer: First Health Commercial |
$3,977.06
|
| Rate for Payer: Humana Commercial |
$3,558.42
|
| Rate for Payer: Humana KY Medicaid |
$1,439.70
|
| Rate for Payer: Humana Medicare Advantage |
$620.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,454.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,432.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,089.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,468.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,684.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,139.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,297.78
|
| Rate for Payer: PHCS Commercial |
$4,018.92
|
| Rate for Payer: United Healthcare All Payer |
$3,684.01
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.32
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$544.23 |
| Max. Negotiated Rate |
$4,018.92 |
| Rate for Payer: Aetna Commercial |
$3,223.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,265.38
|
| Rate for Payer: Cash Price |
$2,093.19
|
| Rate for Payer: Cigna Commercial |
$3,474.70
|
| Rate for Payer: First Health Commercial |
$3,977.06
|
| Rate for Payer: Humana Commercial |
$3,558.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,432.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,089.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,255.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,684.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,139.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,297.78
|
| Rate for Payer: PHCS Commercial |
$4,018.92
|
| Rate for Payer: United Healthcare All Payer |
$3,684.01
|
|
|
RADIOELEMENT APPLICATION
|
Professional
|
Both
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$327.21 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$743.90
|
| Rate for Payer: Anthem Medicaid |
$327.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,872.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$662.65
|
| Rate for Payer: Healthspan PPO |
$627.34
|
| Rate for Payer: Humana Medicaid |
$327.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$367.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$333.75
|
| Rate for Payer: Molina Healthcare Passport |
$327.21
|
| Rate for Payer: Multiplan PHCS |
$1,123.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,310.40
|
| Rate for Payer: UHCCP Medicaid |
$655.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.48
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$509.05 |
| Max. Negotiated Rate |
$4,387.20 |
| Rate for Payer: Aetna Commercial |
$3,518.90
|
| Rate for Payer: Anthem Medicaid |
$1,571.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$509.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,564.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$712.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.22
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cigna Commercial |
$3,793.10
|
| Rate for Payer: First Health Commercial |
$4,341.50
|
| Rate for Payer: Humana Commercial |
$3,884.50
|
| Rate for Payer: Humana KY Medicaid |
$1,571.62
|
| Rate for Payer: Humana Medicare Advantage |
$509.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,587.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,747.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,372.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,603.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,021.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.70
|
| Rate for Payer: PHCS Commercial |
$4,387.20
|
| Rate for Payer: United Healthcare All Payer |
$4,021.60
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$594.10 |
| Max. Negotiated Rate |
$4,387.20 |
| Rate for Payer: Aetna Commercial |
$3,518.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,564.60
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cigna Commercial |
$3,793.10
|
| Rate for Payer: First Health Commercial |
$4,341.50
|
| Rate for Payer: Humana Commercial |
$3,884.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,747.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,372.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,021.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.70
|
| Rate for Payer: PHCS Commercial |
$4,387.20
|
| Rate for Payer: United Healthcare All Payer |
$4,021.60
|
|
|
RADIOELEMENT APPLICATION
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$220.69 |
| Max. Negotiated Rate |
$4,570.00 |
| Rate for Payer: Aetna Commercial |
$543.21
|
| Rate for Payer: Anthem Medicaid |
$220.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,570.00
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Healthspan PPO |
$458.10
|
| Rate for Payer: Humana Medicaid |
$220.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$225.10
|
| Rate for Payer: Molina Healthcare Passport |
$220.69
|
| Rate for Payer: Multiplan PHCS |
$2,742.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,199.00
|
| Rate for Payer: UHCCP Medicaid |
$1,599.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.90
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem Medicaid |
$643.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$509.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$712.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.22
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Humana KY Medicaid |
$643.78
|
| Rate for Payer: Humana Medicare Advantage |
$509.05
|
| Rate for Payer: Kentucky WC Medicaid |
$650.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.32
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$620.01 |
| Max. Negotiated Rate |
$6,300.14 |
| Rate for Payer: Aetna Commercial |
$5,053.24
|
| Rate for Payer: Anthem Medicaid |
$2,256.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$620.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$868.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.01
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cigna Commercial |
$5,447.00
|
| Rate for Payer: First Health Commercial |
$6,234.52
|
| Rate for Payer: Humana Commercial |
$5,578.25
|
| Rate for Payer: Humana KY Medicaid |
$2,256.90
|
| Rate for Payer: Humana Medicare Advantage |
$620.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,279.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,302.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.13
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.42
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
333T0044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$853.14 |
| Max. Negotiated Rate |
$6,300.14 |
| Rate for Payer: Aetna Commercial |
$5,053.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cigna Commercial |
$5,447.00
|
| Rate for Payer: First Health Commercial |
$6,234.52
|
| Rate for Payer: Humana Commercial |
$5,578.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.13
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.42
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
OP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
333T0042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem Medicaid |
$643.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$509.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$712.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.22
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Humana KY Medicaid |
$643.78
|
| Rate for Payer: Humana Medicare Advantage |
$509.05
|
| Rate for Payer: Kentucky WC Medicaid |
$650.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.32
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
333T0042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.32
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
