|
RADICAL RESECT OF TUMOR(T
|
Facility
|
IP
|
$7,968.00
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
761T0366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,390.40 |
| Max. Negotiated Rate |
$7,649.28 |
| Rate for Payer: Aetna Commercial |
$6,135.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,215.04
|
| Rate for Payer: Cash Price |
$3,984.00
|
| Rate for Payer: Cigna Commercial |
$6,613.44
|
| Rate for Payer: First Health Commercial |
$7,569.60
|
| Rate for Payer: Humana Commercial |
$6,772.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,533.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,880.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,390.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,011.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,932.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,497.92
|
| Rate for Payer: PHCS Commercial |
$7,649.28
|
| Rate for Payer: United Healthcare All Payer |
$7,011.84
|
|
|
RADICAL RESECT TUMOR CLAVICLE
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
RADICAL RESECT TUMOR CLAVICLE
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem Medicaid |
$1,134.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Humana KY Medicaid |
$1,134.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
RADICAL RESECT TUMOR CLAVICLE
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Aetna Commercial |
$1,303.66
|
| Rate for Payer: Ambetter Exchange |
$1,428.26
|
| Rate for Payer: Anthem Medicaid |
$600.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,428.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,428.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,713.91
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$1,410.67
|
| Rate for Payer: Healthspan PPO |
$1,180.84
|
| Rate for Payer: Humana Medicaid |
$600.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,774.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,428.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.84
|
| Rate for Payer: Molina Healthcare Passport |
$600.82
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,856.74
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,428.26
|
|
|
RADICAL RESECT TUMOR CLAVICL(P
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 23200
|
| Hospital Charge Code |
761P0451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,980.00 |
| Rate for Payer: Aetna Commercial |
$1,303.66
|
| Rate for Payer: Ambetter Exchange |
$1,428.26
|
| Rate for Payer: Anthem Medicaid |
$600.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,428.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,428.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,713.91
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$1,410.67
|
| Rate for Payer: Healthspan PPO |
$1,180.84
|
| Rate for Payer: Humana Medicaid |
$600.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,774.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,428.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.84
|
| Rate for Payer: Molina Healthcare Passport |
$600.82
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,856.74
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,428.26
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| 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 |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,564.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| 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 |
$534.49
|
| 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 |
$641.39
|
| 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 |
$3,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,975.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,153.30
|
| Rate for Payer: PHCS Commercial |
$4,387.20
|
| Rate for Payer: United Healthcare All Payer |
$4,021.60
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$641.07 |
| 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 |
$641.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$897.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$865.44
|
| 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 |
$641.07
|
| 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 |
$769.28
|
| 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 |
$5,250.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,709.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,528.23
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,968.80 |
| Max. Negotiated Rate |
$6,300.14 |
| Rate for Payer: Aetna Commercial |
$5,053.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cigna Commercial |
$5,447.00
|
| Rate for Payer: First Health Commercial |
$6,234.52
|
| Rate for Payer: Humana Commercial |
$5,578.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.13
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,250.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,709.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,528.23
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$220.69 |
| Max. Negotiated Rate |
$2,742.00 |
| Rate for Payer: Aetna Commercial |
$543.21
|
| Rate for Payer: Ambetter Exchange |
$389.47
|
| Rate for Payer: Anthem Medicaid |
$220.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$389.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$389.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$467.36
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cash Price |
$2,285.00
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Healthspan PPO |
$458.10
|
| Rate for Payer: Humana Medicaid |
$220.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$244.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$389.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$389.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$225.10
|
| Rate for Payer: Molina Healthcare Passport |
$220.69
|
| Rate for Payer: Multiplan PHCS |
$2,742.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$506.31
|
| Rate for Payer: UHCCP Medicaid |
$1,599.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$389.47
|
|
|
RADIOELEMENT APPLICATION
|
Professional
|
Both
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$327.21 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$743.90
|
| Rate for Payer: Ambetter Exchange |
$514.34
|
| Rate for Payer: Anthem Medicaid |
$327.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$514.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$514.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$617.21
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$662.65
|
| Rate for Payer: Healthspan PPO |
$627.35
|
| Rate for Payer: Humana Medicaid |
$327.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$367.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$514.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$333.75
|
| Rate for Payer: Molina Healthcare Passport |
$327.21
|
| Rate for Payer: Multiplan PHCS |
$1,123.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.64
|
| Rate for Payer: UHCCP Medicaid |
$655.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$514.34
|
|
|
RADIOELEMENT APPLICATION
|
Professional
|
Both
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$464.57 |
| Max. Negotiated Rate |
$2,511.83 |
| Rate for Payer: Aetna Commercial |
$1,054.08
|
| Rate for Payer: Ambetter Exchange |
$732.10
|
| Rate for Payer: Anthem Medicaid |
$464.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$732.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$732.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$878.52
|
| Rate for Payer: Cash Price |
$2,093.19
|
| Rate for Payer: Cash Price |
$2,093.19
|
| Rate for Payer: Cigna Commercial |
$936.56
|
| Rate for Payer: Healthspan PPO |
$888.92
|
| Rate for Payer: Humana Medicaid |
$464.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$552.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.86
|
| Rate for Payer: Molina Healthcare Passport |
$464.57
|
| Rate for Payer: Multiplan PHCS |
$2,511.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$951.73
|
| Rate for Payer: UHCCP Medicaid |
$1,465.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$732.10
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,255.91 |
| 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 |
$3,349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,642.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.60
|
| Rate for Payer: PHCS Commercial |
$4,018.92
|
| Rate for Payer: United Healthcare All Payer |
$3,684.01
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
33300043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$641.07 |
| 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 |
$641.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,265.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$897.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$865.44
|
| 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 |
$641.07
|
| 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 |
$769.28
|
| 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 |
$3,349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,642.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.60
|
| Rate for Payer: PHCS Commercial |
$4,018.92
|
| Rate for Payer: United Healthcare All Payer |
$3,684.01
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
33300041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,371.00 |
| 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 |
$3,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,975.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,153.30
|
| Rate for Payer: PHCS Commercial |
$4,387.20
|
| Rate for Payer: United Healthcare All Payer |
$4,021.60
|
|
|
RADIOELEMENT APPLICATION
|
Professional
|
Both
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
33300044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$587.70 |
| Max. Negotiated Rate |
$3,937.59 |
| Rate for Payer: Aetna Commercial |
$1,280.80
|
| Rate for Payer: Ambetter Exchange |
$854.27
|
| Rate for Payer: Anthem Medicaid |
$587.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$854.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$854.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,025.12
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cigna Commercial |
$1,161.14
|
| Rate for Payer: Healthspan PPO |
$1,080.12
|
| Rate for Payer: Humana Medicaid |
$587.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$723.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$854.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$854.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$599.45
|
| Rate for Payer: Molina Healthcare Passport |
$587.70
|
| Rate for Payer: Multiplan PHCS |
$3,937.59
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,110.55
|
| Rate for Payer: UHCCP Medicaid |
$2,296.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$593.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$854.27
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
IP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.68
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION
|
Facility
|
OP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
33300042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem Medicaid |
$643.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Humana KY Medicaid |
$643.78
|
| Rate for Payer: Humana Medicare Advantage |
$534.49
|
| Rate for Payer: Kentucky WC Medicaid |
$650.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.68
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
OP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
333T0042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem Medicaid |
$643.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Humana KY Medicaid |
$643.78
|
| Rate for Payer: Humana Medicare Advantage |
$534.49
|
| Rate for Payer: Kentucky WC Medicaid |
$650.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.68
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
333T0044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,968.80 |
| Max. Negotiated Rate |
$6,300.14 |
| Rate for Payer: Aetna Commercial |
$5,053.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Cash Price |
$3,281.32
|
| Rate for Payer: Cigna Commercial |
$5,447.00
|
| Rate for Payer: First Health Commercial |
$6,234.52
|
| Rate for Payer: Humana Commercial |
$5,578.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.13
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,250.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,709.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,528.23
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
OP
|
$6,562.65
|
|
|
Service Code
|
HCPCS 77778
|
| Hospital Charge Code |
333T0044
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$641.07 |
| 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 |
$641.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$897.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$865.44
|
| 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 |
$641.07
|
| 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 |
$769.28
|
| 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 |
$5,250.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,709.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,528.23
|
| Rate for Payer: PHCS Commercial |
$6,300.14
|
| Rate for Payer: United Healthcare All Payer |
$5,775.13
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
OP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
333T0041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| 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 |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,564.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| 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 |
$534.49
|
| 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 |
$641.39
|
| 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 |
$3,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,975.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,153.30
|
| Rate for Payer: PHCS Commercial |
$4,387.20
|
| Rate for Payer: United Healthcare All Payer |
$4,021.60
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
333T0043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,255.91 |
| 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 |
$3,349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,642.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.60
|
| Rate for Payer: PHCS Commercial |
$4,018.92
|
| Rate for Payer: United Healthcare All Payer |
$3,684.01
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$1,872.00
|
|
|
Service Code
|
HCPCS 77762
|
| Hospital Charge Code |
333T0042
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$1,797.12 |
| Rate for Payer: Aetna Commercial |
$1,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.16
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,553.76
|
| Rate for Payer: First Health Commercial |
$1,778.40
|
| Rate for Payer: Humana Commercial |
$1,591.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.68
|
| Rate for Payer: PHCS Commercial |
$1,797.12
|
| Rate for Payer: United Healthcare All Payer |
$1,647.36
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
IP
|
$4,570.00
|
|
|
Service Code
|
HCPCS 77761
|
| Hospital Charge Code |
333T0041
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,371.00 |
| 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 |
$3,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,975.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,153.30
|
| Rate for Payer: PHCS Commercial |
$4,387.20
|
| Rate for Payer: United Healthcare All Payer |
$4,021.60
|
|
|
RADIOELEMENT APPLICATION(T
|
Facility
|
OP
|
$4,186.38
|
|
|
Service Code
|
HCPCS 77763
|
| Hospital Charge Code |
333T0043
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$641.07 |
| 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 |
$641.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,265.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$897.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$865.44
|
| 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 |
$641.07
|
| 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 |
$769.28
|
| 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 |
$3,349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,642.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.60
|
| Rate for Payer: PHCS Commercial |
$4,018.92
|
| Rate for Payer: United Healthcare All Payer |
$3,684.01
|
|
