|
RADIOLOGIC EXAM WRIST 2 VIEW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
320P0084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$42.42
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| 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 |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.75
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| 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 |
$20.35
|
|
|
RADIOLOGIC EXAM WRIST 2 VIEWS
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
32000084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem Medicaid |
$131.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Humana KY Medicaid |
$131.37
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$132.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
RADIOLOGIC EXAM WRIST 2 VIEWS
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
32000084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$42.42
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$40.29
|
| Rate for Payer: Healthspan PPO |
$39.75
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$229.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$133.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
|
RADIOLOGIC EXAM WRIST 2 VIEWS
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
32000084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
RADIOLOGIC EXAM WRIST 2 VIEW(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
320T0084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
RADIOLOGIC EXAM WRIST 2 VIEW(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
320T0084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
RADIOPHARMACEUTICAL THERAPY
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
34000126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$1,406.40 |
| Rate for Payer: Aetna Commercial |
$1,128.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,142.70
|
| Rate for Payer: Cash Price |
$732.50
|
| Rate for Payer: Cigna Commercial |
$1,215.95
|
| Rate for Payer: First Health Commercial |
$1,391.75
|
| Rate for Payer: Humana Commercial |
$1,245.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,201.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,081.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$439.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,289.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,098.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$454.15
|
| Rate for Payer: PHCS Commercial |
$1,406.40
|
| Rate for Payer: United Healthcare All Payer |
$1,289.20
|
|
|
RADIOPHARMACEUTICAL THERAPY
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
34000126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$1,465.00 |
| Rate for Payer: Aetna Commercial |
$338.59
|
| Rate for Payer: Anthem Medicaid |
$203.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,465.00
|
| Rate for Payer: Cash Price |
$732.50
|
| Rate for Payer: Cash Price |
$732.50
|
| Rate for Payer: Cigna Commercial |
$384.86
|
| Rate for Payer: Healthspan PPO |
$338.42
|
| Rate for Payer: Humana Medicaid |
$203.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.08
|
| Rate for Payer: Molina Healthcare Passport |
$203.02
|
| Rate for Payer: Multiplan PHCS |
$879.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,025.50
|
| Rate for Payer: UHCCP Medicaid |
$512.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.05
|
|
|
RADIOPHARMACEUTICAL THERAPY
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
34000126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$1,406.40 |
| Rate for Payer: Aetna Commercial |
$1,128.05
|
| Rate for Payer: Anthem Medicaid |
$503.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$215.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,142.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$301.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$732.50
|
| Rate for Payer: Cash Price |
$732.50
|
| Rate for Payer: Cigna Commercial |
$1,215.95
|
| Rate for Payer: First Health Commercial |
$1,391.75
|
| Rate for Payer: Humana Commercial |
$1,245.25
|
| Rate for Payer: Humana KY Medicaid |
$503.81
|
| Rate for Payer: Humana Medicare Advantage |
$215.14
|
| Rate for Payer: Kentucky WC Medicaid |
$508.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,201.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,081.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,289.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,098.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$454.15
|
| Rate for Payer: PHCS Commercial |
$1,406.40
|
| Rate for Payer: United Healthcare All Payer |
$1,289.20
|
|
|
RADIOPHARMACEUTICAL THERAPY(P
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
340P0126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$384.86 |
| Rate for Payer: Aetna Commercial |
$338.59
|
| Rate for Payer: Anthem Medicaid |
$203.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$384.86
|
| Rate for Payer: Healthspan PPO |
$338.42
|
| Rate for Payer: Humana Medicaid |
$203.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.08
|
| Rate for Payer: Molina Healthcare Passport |
$203.02
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.05
|
|
|
RADIOPHARMACEUTICAL THERAPY(T
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
340T0126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RADIOPHARMACEUTICAL THERAPY(T
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
340T0126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$215.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$301.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$215.14
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RADIOPHARM LOC OF TUMOR;MULT
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
34000034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.07 |
| Max. Negotiated Rate |
$1,381.44 |
| Rate for Payer: Aetna Commercial |
$1,108.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,122.42
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cigna Commercial |
$1,194.37
|
| Rate for Payer: First Health Commercial |
$1,367.05
|
| Rate for Payer: Humana Commercial |
$1,223.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,179.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,061.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,266.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,079.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.09
|
| Rate for Payer: PHCS Commercial |
$1,381.44
|
| Rate for Payer: United Healthcare All Payer |
$1,266.32
|
|
|
RADIOPHARM LOC OF TUMOR;MULT
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
34000034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.07 |
| Max. Negotiated Rate |
$1,381.44 |
| Rate for Payer: Aetna Commercial |
$1,108.03
|
| Rate for Payer: Anthem Medicaid |
$494.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,122.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cigna Commercial |
$1,194.37
|
| Rate for Payer: First Health Commercial |
$1,367.05
|
| Rate for Payer: Humana Commercial |
$1,223.15
|
| Rate for Payer: Humana KY Medicaid |
$494.87
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$499.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,179.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,061.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$504.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,266.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,079.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.09
|
| Rate for Payer: PHCS Commercial |
$1,381.44
|
| Rate for Payer: United Healthcare All Payer |
$1,266.32
|
|
|
RADIOPHARM LOC OF TUMOR;MULT
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
34000034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$1,439.00 |
| Rate for Payer: Aetna Commercial |
$366.68
|
| Rate for Payer: Anthem Medicaid |
$213.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,439.00
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cigna Commercial |
$322.45
|
| Rate for Payer: Healthspan PPO |
$366.50
|
| Rate for Payer: Humana Medicaid |
$213.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.41
|
| Rate for Payer: Molina Healthcare Passport |
$213.15
|
| Rate for Payer: Multiplan PHCS |
$863.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,007.30
|
| Rate for Payer: UHCCP Medicaid |
$503.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.28
|
|
|
RADIOPHARM LOC OF TUMOR;MULT(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
340P0034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna Commercial |
$366.68
|
| Rate for Payer: Anthem Medicaid |
$213.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$322.45
|
| Rate for Payer: Healthspan PPO |
$366.50
|
| Rate for Payer: Humana Medicaid |
$213.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.41
|
| Rate for Payer: Molina Healthcare Passport |
$213.15
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.28
|
|
|
RADIOPHARM LOC OF TUMOR;MULT(T
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
340T0034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.57 |
| Max. Negotiated Rate |
$1,237.44 |
| Rate for Payer: Aetna Commercial |
$992.53
|
| Rate for Payer: Anthem Medicaid |
$443.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,005.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cigna Commercial |
$1,069.87
|
| Rate for Payer: First Health Commercial |
$1,224.55
|
| Rate for Payer: Humana Commercial |
$1,095.65
|
| Rate for Payer: Humana KY Medicaid |
$443.29
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$447.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,056.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$951.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,134.32
|
| Rate for Payer: Ohio Health Group HMO |
$966.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.59
|
| Rate for Payer: PHCS Commercial |
$1,237.44
|
| Rate for Payer: United Healthcare All Payer |
$1,134.32
|
|
|
RADIOPHARM LOC OF TUMOR;MULT(T
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
340T0034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.57 |
| Max. Negotiated Rate |
$1,237.44 |
| Rate for Payer: Aetna Commercial |
$992.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,005.42
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cigna Commercial |
$1,069.87
|
| Rate for Payer: First Health Commercial |
$1,224.55
|
| Rate for Payer: Humana Commercial |
$1,095.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,056.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$951.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,134.32
|
| Rate for Payer: Ohio Health Group HMO |
$966.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.59
|
| Rate for Payer: PHCS Commercial |
$1,237.44
|
| Rate for Payer: United Healthcare All Payer |
$1,134.32
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
34000036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.08 |
| Max. Negotiated Rate |
$2,799.36 |
| Rate for Payer: Aetna Commercial |
$2,245.32
|
| Rate for Payer: Anthem Medicaid |
$1,002.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,274.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna Commercial |
$2,420.28
|
| Rate for Payer: First Health Commercial |
$2,770.20
|
| Rate for Payer: Humana Commercial |
$2,478.60
|
| Rate for Payer: Humana KY Medicaid |
$1,002.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,013.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,391.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,152.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,022.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,566.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,187.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$583.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$379.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.96
|
| Rate for Payer: PHCS Commercial |
$2,799.36
|
| Rate for Payer: United Healthcare All Payer |
$2,566.08
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
34000036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.08 |
| Max. Negotiated Rate |
$2,799.36 |
| Rate for Payer: Aetna Commercial |
$2,245.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,274.48
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna Commercial |
$2,420.28
|
| Rate for Payer: First Health Commercial |
$2,770.20
|
| Rate for Payer: Humana Commercial |
$2,478.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,391.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,152.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,566.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,187.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$583.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$379.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$903.96
|
| Rate for Payer: PHCS Commercial |
$2,799.36
|
| Rate for Payer: United Healthcare All Payer |
$2,566.08
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
340P0036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$561.93 |
| Rate for Payer: Aetna Commercial |
$529.18
|
| Rate for Payer: Anthem Medicaid |
$291.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$561.93
|
| Rate for Payer: Healthspan PPO |
$528.91
|
| Rate for Payer: Humana Medicaid |
$291.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.74
|
| Rate for Payer: Molina Healthcare Passport |
$291.90
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.82
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
34000036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$2,916.00 |
| Rate for Payer: Aetna Commercial |
$529.18
|
| Rate for Payer: Anthem Medicaid |
$291.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,916.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna Commercial |
$561.93
|
| Rate for Payer: Healthspan PPO |
$528.91
|
| Rate for Payer: Humana Medicaid |
$291.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.74
|
| Rate for Payer: Molina Healthcare Passport |
$291.90
|
| Rate for Payer: Multiplan PHCS |
$1,749.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,041.20
|
| Rate for Payer: UHCCP Medicaid |
$1,020.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.82
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
IP
|
$2,716.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
340T0036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$353.08 |
| Max. Negotiated Rate |
$2,607.36 |
| Rate for Payer: Aetna Commercial |
$2,091.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,118.48
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: Cigna Commercial |
$2,254.28
|
| Rate for Payer: First Health Commercial |
$2,580.20
|
| Rate for Payer: Humana Commercial |
$2,308.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,227.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,004.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$814.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,390.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,037.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$543.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$353.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.96
|
| Rate for Payer: PHCS Commercial |
$2,607.36
|
| Rate for Payer: United Healthcare All Payer |
$2,390.08
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
OP
|
$2,716.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
340T0036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$353.08 |
| Max. Negotiated Rate |
$2,607.36 |
| Rate for Payer: Aetna Commercial |
$2,091.32
|
| Rate for Payer: Anthem Medicaid |
$934.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,118.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: Cash Price |
$1,358.00
|
| Rate for Payer: Cigna Commercial |
$2,254.28
|
| Rate for Payer: First Health Commercial |
$2,580.20
|
| Rate for Payer: Humana Commercial |
$2,308.60
|
| Rate for Payer: Humana KY Medicaid |
$934.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$943.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,227.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,004.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$952.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,390.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,037.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$543.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$353.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.96
|
| Rate for Payer: PHCS Commercial |
$2,607.36
|
| Rate for Payer: United Healthcare All Payer |
$2,390.08
|
|
|
RADIO PHARM OF TUMOR
|
Facility
|
OP
|
$3,832.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$498.16 |
| Max. Negotiated Rate |
$3,678.72 |
| Rate for Payer: Aetna Commercial |
$2,950.64
|
| Rate for Payer: Anthem Medicaid |
$1,317.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,988.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,916.00
|
| Rate for Payer: Cash Price |
$1,916.00
|
| Rate for Payer: Cigna Commercial |
$3,180.56
|
| Rate for Payer: First Health Commercial |
$3,640.40
|
| Rate for Payer: Humana Commercial |
$3,257.20
|
| Rate for Payer: Humana KY Medicaid |
$1,317.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,331.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,142.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,828.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,344.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,372.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,874.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$766.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$498.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,187.92
|
| Rate for Payer: PHCS Commercial |
$3,678.72
|
| Rate for Payer: United Healthcare All Payer |
$3,372.16
|
|
