|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
333T0043
|
|
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(T
|
Facility
|
OP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
333T0043
|
|
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(T
|
Facility
|
IP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
333T0041
|
|
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(T
|
Facility
|
OP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
333T0041
|
|
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(T
|
Facility
|
OP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
333T0044
|
|
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 HANDLING
|
Facility
|
OP
|
$723.10
|
|
|
Service Code
|
HCPCS 77790
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$556.79
|
| Rate for Payer: Anthem Medicaid |
$248.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.02
|
| Rate for Payer: Cash Price |
$361.55
|
| Rate for Payer: Cigna Commercial |
$600.17
|
| Rate for Payer: First Health Commercial |
$686.94
|
| Rate for Payer: Humana Commercial |
$614.64
|
| Rate for Payer: Humana KY Medicaid |
$248.67
|
| Rate for Payer: Kentucky WC Medicaid |
$251.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$592.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$533.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$253.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$636.33
|
| Rate for Payer: Ohio Health Group HMO |
$542.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.16
|
| Rate for Payer: PHCS Commercial |
$694.18
|
| Rate for Payer: United Healthcare All Payer |
$636.33
|
|
|
RADIOELEMENT HANDLING
|
Facility
|
IP
|
$723.10
|
|
|
Service Code
|
HCPCS 77790
|
| Hospital Charge Code |
33300045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$556.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.02
|
| Rate for Payer: Cash Price |
$361.55
|
| Rate for Payer: Cigna Commercial |
$600.17
|
| Rate for Payer: First Health Commercial |
$686.94
|
| Rate for Payer: Humana Commercial |
$614.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$592.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$533.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$636.33
|
| Rate for Payer: Ohio Health Group HMO |
$542.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.16
|
| Rate for Payer: PHCS Commercial |
$694.18
|
| Rate for Payer: United Healthcare All Payer |
$636.33
|
|
|
RADIOELEMENT HANDLING(T
|
Facility
|
OP
|
$723.10
|
|
|
Service Code
|
HCPCS 77790
|
| Hospital Charge Code |
333T0045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$556.79
|
| Rate for Payer: Anthem Medicaid |
$248.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.02
|
| Rate for Payer: Cash Price |
$361.55
|
| Rate for Payer: Cigna Commercial |
$600.17
|
| Rate for Payer: First Health Commercial |
$686.94
|
| Rate for Payer: Humana Commercial |
$614.64
|
| Rate for Payer: Humana KY Medicaid |
$248.67
|
| Rate for Payer: Kentucky WC Medicaid |
$251.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$592.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$533.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$253.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$636.33
|
| Rate for Payer: Ohio Health Group HMO |
$542.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.16
|
| Rate for Payer: PHCS Commercial |
$694.18
|
| Rate for Payer: United Healthcare All Payer |
$636.33
|
|
|
RADIOELEMENT HANDLING(T
|
Facility
|
IP
|
$723.10
|
|
|
Service Code
|
HCPCS 77790
|
| Hospital Charge Code |
333T0045
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$556.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.02
|
| Rate for Payer: Cash Price |
$361.55
|
| Rate for Payer: Cigna Commercial |
$600.17
|
| Rate for Payer: First Health Commercial |
$686.94
|
| Rate for Payer: Humana Commercial |
$614.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$592.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$533.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$636.33
|
| Rate for Payer: Ohio Health Group HMO |
$542.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.16
|
| Rate for Payer: PHCS Commercial |
$694.18
|
| Rate for Payer: United Healthcare All Payer |
$636.33
|
|
|
RADIOFR ABLAT LUMB/SAC EA AD(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
761P2349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.94
|
| Rate for Payer: Anthem Medicaid |
$49.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$108.27
|
| Rate for Payer: Healthspan PPO |
$172.88
|
| Rate for Payer: Humana Medicaid |
$49.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.63
|
| Rate for Payer: Molina Healthcare Passport |
$49.64
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$31.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.14
|
|
|
RADIOFREQ ABLAT LUMB/SAC EA AD
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
76102349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
RADIOFREQ ABLAT LUMB/SAC EA AD
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
76102349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.94
|
| Rate for Payer: Anthem Medicaid |
$49.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$108.27
|
| Rate for Payer: Healthspan PPO |
$172.88
|
| Rate for Payer: Humana Medicaid |
$49.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$77.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.63
|
| Rate for Payer: Molina Healthcare Passport |
$49.64
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$31.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.14
|
|
|
RADIOFREQ ABLAT LUMB/SAC EA AD
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 64636
|
| Hospital Charge Code |
76102349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
RADIOFREQ ABLAT LUMB/SAC FCT J
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
76102348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.40
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
RADIOFREQ ABLAT LUMB/SAC FCT J
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
76102348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.25
|
| Rate for Payer: Anthem Medicaid |
$185.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$405.37
|
| Rate for Payer: Healthspan PPO |
$415.50
|
| Rate for Payer: Humana Medicaid |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.01
|
| Rate for Payer: Molina Healthcare Passport |
$185.30
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$102.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.15
|
|
|
RADIOFREQ ABLAT LUMB/SAC FCT J
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
76102348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.40
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
RADIOFREQ ABLAT LUMN/SAC FAC(P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
761P2348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.25
|
| Rate for Payer: Anthem Medicaid |
$185.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$405.37
|
| Rate for Payer: Healthspan PPO |
$415.50
|
| Rate for Payer: Humana Medicaid |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.01
|
| Rate for Payer: Molina Healthcare Passport |
$185.30
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$102.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.15
|
|
|
RADIOFREQUENCY ABLATION, NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY)
|
Facility
|
OP
|
$2,337.51
|
|
|
Service Code
|
CPT 64625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,669.65 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
|
|
RADIOLOGIC EXAM CLAVICLE, COMP
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
RADIOLOGIC EXAM CLAVICLE, COMP
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320T0275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$89.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$89.41
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$90.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
RADIOLOGIC EXAM CLAVICLE, COMP
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320T0275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
RADIOLOGIC EXAM CLAVICLE, COMP
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.74
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
|
|
RADIOLOGIC EXAM CLAVICLE, COMP
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
RADIOLOGIC EXAM CLAVICLE, COMP
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320P0275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.74
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
|
|
RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW
|
Facility
|
OP
|
$110.01
|
|
|
Service Code
|
CPT 71045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$110.01 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
|
