|
RADIATION THPY PLANNING
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$112.52
|
| Rate for Payer: Ambetter Exchange |
$66.45
|
| Rate for Payer: Anthem Medicaid |
$59.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.74
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$105.88
|
| Rate for Payer: Healthspan PPO |
$94.89
|
| Rate for Payer: Humana Medicaid |
$59.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.79
|
| Rate for Payer: Molina Healthcare Passport |
$59.60
|
| Rate for Payer: Multiplan PHCS |
$353.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.39
|
| Rate for Payer: UHCCP Medicaid |
$206.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.45
|
|
|
RADIATION THPY PLANNING
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RADIATION THPY PLANNING
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$453.53
|
| Rate for Payer: Anthem Medicaid |
$202.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$459.42
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: First Health Commercial |
$559.55
|
| Rate for Payer: Humana Commercial |
$500.65
|
| Rate for Payer: Humana KY Medicaid |
$202.56
|
| Rate for Payer: Kentucky WC Medicaid |
$204.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$518.32
|
| Rate for Payer: Ohio Health Group HMO |
$441.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.41
|
| Rate for Payer: PHCS Commercial |
$565.44
|
| Rate for Payer: United Healthcare All Payer |
$518.32
|
|
|
RADIATION THPY PLANNING
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
RADIATION THPY PLANNING
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RADIATION THPY PLANNING
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
RADIATION THPY PLANNING
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$453.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$459.42
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: First Health Commercial |
$559.55
|
| Rate for Payer: Humana Commercial |
$500.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$518.32
|
| Rate for Payer: Ohio Health Group HMO |
$441.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.41
|
| Rate for Payer: PHCS Commercial |
$565.44
|
| Rate for Payer: United Healthcare All Payer |
$518.32
|
|
|
RADIATION THPY PLANNING
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
33300035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$169.25
|
| Rate for Payer: Ambetter Exchange |
$102.92
|
| Rate for Payer: Anthem Medicaid |
$90.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$159.21
|
| Rate for Payer: Healthspan PPO |
$142.74
|
| Rate for Payer: Humana Medicaid |
$90.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.34
|
| Rate for Payer: Molina Healthcare Passport |
$90.53
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.80
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.92
|
|
|
RADIATION THPY PLANNING(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
333P0034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$112.52
|
| Rate for Payer: Ambetter Exchange |
$66.45
|
| Rate for Payer: Anthem Medicaid |
$59.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.74
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$105.88
|
| Rate for Payer: Healthspan PPO |
$94.89
|
| Rate for Payer: Humana Medicaid |
$59.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$92.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.79
|
| Rate for Payer: Molina Healthcare Passport |
$59.60
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.39
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.45
|
|
|
RADIATION THPY PLANNING(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
333P0036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$251.01
|
| Rate for Payer: Ambetter Exchange |
$160.27
|
| Rate for Payer: Anthem Medicaid |
$134.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$160.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$192.32
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$236.20
|
| Rate for Payer: Healthspan PPO |
$211.68
|
| Rate for Payer: Humana Medicaid |
$134.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$160.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.24
|
| Rate for Payer: Molina Healthcare Passport |
$134.55
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.35
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$160.27
|
|
|
RADIATION THPY PLANNING(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
333P0035
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$169.25
|
| Rate for Payer: Ambetter Exchange |
$102.92
|
| Rate for Payer: Anthem Medicaid |
$90.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$159.21
|
| Rate for Payer: Healthspan PPO |
$142.74
|
| Rate for Payer: Humana Medicaid |
$90.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.34
|
| Rate for Payer: Molina Healthcare Passport |
$90.53
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.80
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.92
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
333T0036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem Medicaid |
$287.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Humana KY Medicaid |
$287.50
|
| Rate for Payer: Kentucky WC Medicaid |
$290.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
333T0034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Anthem Medicaid |
$99.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$225.42
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$239.87
|
| Rate for Payer: First Health Commercial |
$274.55
|
| Rate for Payer: Humana Commercial |
$245.65
|
| Rate for Payer: Humana KY Medicaid |
$99.39
|
| Rate for Payer: Kentucky WC Medicaid |
$100.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$213.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$254.32
|
| Rate for Payer: Ohio Health Group HMO |
$216.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.41
|
| Rate for Payer: PHCS Commercial |
$277.44
|
| Rate for Payer: United Healthcare All Payer |
$254.32
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
333T0034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$222.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$225.42
|
| Rate for Payer: Cash Price |
$144.50
|
| Rate for Payer: Cigna Commercial |
$239.87
|
| Rate for Payer: First Health Commercial |
$274.55
|
| Rate for Payer: Humana Commercial |
$245.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$213.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$254.32
|
| Rate for Payer: Ohio Health Group HMO |
$216.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.41
|
| Rate for Payer: PHCS Commercial |
$277.44
|
| Rate for Payer: United Healthcare All Payer |
$254.32
|
|
|
RADIATION THPY PLANNING(T
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
333T0036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
RADIATION TREAT AID
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$463.80 |
| Max. Negotiated Rate |
$1,484.16 |
| Rate for Payer: Aetna Commercial |
$1,190.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.88
|
| Rate for Payer: Cash Price |
$773.00
|
| Rate for Payer: Cigna Commercial |
$1,283.18
|
| Rate for Payer: First Health Commercial |
$1,468.70
|
| Rate for Payer: Humana Commercial |
$1,314.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,267.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,360.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,159.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.74
|
| Rate for Payer: PHCS Commercial |
$1,484.16
|
| Rate for Payer: United Healthcare All Payer |
$1,360.48
|
|
|
RADIATION TREAT AID
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$263.70 |
| Max. Negotiated Rate |
$843.84 |
| Rate for Payer: Aetna Commercial |
$676.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$685.62
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cigna Commercial |
$729.57
|
| Rate for Payer: First Health Commercial |
$835.05
|
| Rate for Payer: Humana Commercial |
$747.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$720.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$648.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$773.52
|
| Rate for Payer: Ohio Health Group HMO |
$659.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$764.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$606.51
|
| Rate for Payer: PHCS Commercial |
$843.84
|
| Rate for Payer: United Healthcare All Payer |
$773.52
|
|
|
RADIATION TREAT AID
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$405.72
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
RADIATION TREAT AID
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$843.84 |
| Rate for Payer: Aetna Commercial |
$676.83
|
| Rate for Payer: Anthem Medicaid |
$302.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$685.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cigna Commercial |
$729.57
|
| Rate for Payer: First Health Commercial |
$835.05
|
| Rate for Payer: Humana Commercial |
$747.15
|
| Rate for Payer: Humana KY Medicaid |
$302.29
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$305.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$720.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$648.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$773.52
|
| Rate for Payer: Ohio Health Group HMO |
$659.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$764.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$606.51
|
| Rate for Payer: PHCS Commercial |
$843.84
|
| Rate for Payer: United Healthcare All Payer |
$773.52
|
|
|
RADIATION TREAT AID
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
33300015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$527.40 |
| Rate for Payer: Aetna Commercial |
$109.48
|
| Rate for Payer: Ambetter Exchange |
$123.43
|
| Rate for Payer: Anthem Medicaid |
$87.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$123.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.12
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$92.33
|
| Rate for Payer: Humana Medicaid |
$87.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$123.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.52
|
| Rate for Payer: Molina Healthcare Passport |
$87.76
|
| Rate for Payer: Multiplan PHCS |
$527.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$160.46
|
| Rate for Payer: UHCCP Medicaid |
$307.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.43
|
|
|
RADIATION TREAT AID
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,484.16 |
| Rate for Payer: Aetna Commercial |
$1,190.42
|
| Rate for Payer: Anthem Medicaid |
$531.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$773.00
|
| Rate for Payer: Cash Price |
$773.00
|
| Rate for Payer: Cigna Commercial |
$1,283.18
|
| Rate for Payer: First Health Commercial |
$1,468.70
|
| Rate for Payer: Humana Commercial |
$1,314.10
|
| Rate for Payer: Humana KY Medicaid |
$531.67
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$537.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,267.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,360.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,159.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,345.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.74
|
| Rate for Payer: PHCS Commercial |
$1,484.16
|
| Rate for Payer: United Healthcare All Payer |
$1,360.48
|
|
|
RADIATION TREAT AID
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem Medicaid |
$202.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Humana KY Medicaid |
$202.21
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$204.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$405.72
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
RADIATION TREAT AID
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$352.80 |
| Rate for Payer: Aetna Commercial |
$119.65
|
| Rate for Payer: Ambetter Exchange |
$37.66
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.19
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$118.98
|
| Rate for Payer: Healthspan PPO |
$100.90
|
| Rate for Payer: Humana Medicaid |
$59.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.00
|
| Rate for Payer: Molina Healthcare Passport |
$59.80
|
| Rate for Payer: Multiplan PHCS |
$352.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.96
|
| Rate for Payer: UHCCP Medicaid |
$205.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.66
|
|
|
RADIATION TREAT AID
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$927.60 |
| Rate for Payer: Aetna Commercial |
$244.77
|
| Rate for Payer: Ambetter Exchange |
$115.49
|
| Rate for Payer: Anthem Medicaid |
$140.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.59
|
| Rate for Payer: Cash Price |
$773.00
|
| Rate for Payer: Cash Price |
$773.00
|
| Rate for Payer: Cigna Commercial |
$268.30
|
| Rate for Payer: Healthspan PPO |
$206.41
|
| Rate for Payer: Humana Medicaid |
$140.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$115.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.39
|
| Rate for Payer: Molina Healthcare Passport |
$140.58
|
| Rate for Payer: Multiplan PHCS |
$927.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.14
|
| Rate for Payer: UHCCP Medicaid |
$541.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.49
|
|
|
RADIATION TREAT AID(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
333P0015
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$160.46 |
| Rate for Payer: Aetna Commercial |
$109.48
|
| Rate for Payer: Ambetter Exchange |
$123.43
|
| Rate for Payer: Anthem Medicaid |
$87.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$123.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$148.12
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$92.33
|
| Rate for Payer: Humana Medicaid |
$87.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$123.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.52
|
| Rate for Payer: Molina Healthcare Passport |
$87.76
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$160.46
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.43
|
|
