|
RADIOLOGIC EXAM WRIST 2 VIEW(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
320T0084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
RADIOLOGIC EXAM WRIST 2 VIEW(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
320T0084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
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 |
$879.00 |
| Rate for Payer: Aetna Commercial |
$338.59
|
| Rate for Payer: Ambetter Exchange |
$157.04
|
| Rate for Payer: Anthem Medicaid |
$203.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$157.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.04
|
| 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 |
$204.15
|
| Rate for Payer: UHCCP Medicaid |
$512.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.04
|
|
|
RADIOPHARMACEUTICAL THERAPY
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
34000126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$439.50 |
| 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 |
$1,172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,010.85
|
| Rate for Payer: PHCS Commercial |
$1,406.40
|
| Rate for Payer: United Healthcare All Payer |
$1,289.20
|
|
|
RADIOPHARMACEUTICAL THERAPY
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
34000126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$207.09 |
| 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 |
$207.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,142.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$289.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.57
|
| 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 |
$207.09
|
| 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 |
$248.51
|
| 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 |
$1,172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,010.85
|
| 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: Ambetter Exchange |
$157.04
|
| Rate for Payer: Anthem Medicaid |
$203.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$157.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.04
|
| 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 |
$204.15
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.04
|
|
|
RADIOPHARMACEUTICAL THERAPY(T
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 79403
|
| Hospital Charge Code |
340T0126
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$405.00 |
| 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 |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| 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 |
$207.09 |
| 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 |
$207.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$289.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.57
|
| 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 |
$207.09
|
| 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 |
$248.51
|
| 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 |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
RADIOPHARM LOC OF TUMOR;MULT
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
34000034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$371.28 |
| 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 |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,122.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| 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 |
$371.28
|
| 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 |
$445.54
|
| 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 |
$1,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.91
|
| 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 |
$863.40 |
| Rate for Payer: Aetna Commercial |
$366.68
|
| Rate for Payer: Ambetter Exchange |
$218.08
|
| Rate for Payer: Anthem Medicaid |
$213.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$218.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$218.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.08
|
| 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 |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$503.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$218.08
|
|
|
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 |
$431.70 |
| 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 |
$1,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.91
|
| Rate for Payer: PHCS Commercial |
$1,381.44
|
| Rate for Payer: United Healthcare All Payer |
$1,266.32
|
|
|
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: Ambetter Exchange |
$218.08
|
| Rate for Payer: Anthem Medicaid |
$213.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$218.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$218.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.08
|
| 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 |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$218.08
|
|
|
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 |
$386.70 |
| 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 |
$1,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$889.41
|
| 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
|
OP
|
$1,289.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
340T0034
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$371.28 |
| 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 |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,005.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| 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 |
$371.28
|
| 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 |
$445.54
|
| 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 |
$1,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$889.41
|
| Rate for Payer: PHCS Commercial |
$1,237.44
|
| Rate for Payer: United Healthcare All Payer |
$1,134.32
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
IP
|
$3,093.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
34000036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$927.90 |
| Max. Negotiated Rate |
$2,969.28 |
| Rate for Payer: Aetna Commercial |
$2,381.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.54
|
| Rate for Payer: Cash Price |
$1,546.50
|
| Rate for Payer: Cigna Commercial |
$2,567.19
|
| Rate for Payer: First Health Commercial |
$2,938.35
|
| Rate for Payer: Humana Commercial |
$2,629.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,282.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,721.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,319.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,690.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.17
|
| Rate for Payer: PHCS Commercial |
$2,969.28
|
| Rate for Payer: United Healthcare All Payer |
$2,721.84
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
OP
|
$3,093.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
34000036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,063.68 |
| Max. Negotiated Rate |
$2,969.28 |
| Rate for Payer: Aetna Commercial |
$2,381.61
|
| Rate for Payer: Anthem Medicaid |
$1,063.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$1,546.50
|
| Rate for Payer: Cash Price |
$1,546.50
|
| Rate for Payer: Cigna Commercial |
$2,567.19
|
| Rate for Payer: First Health Commercial |
$2,938.35
|
| Rate for Payer: Humana Commercial |
$2,629.05
|
| Rate for Payer: Humana KY Medicaid |
$1,063.68
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,282.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,721.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,319.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,690.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.17
|
| Rate for Payer: PHCS Commercial |
$2,969.28
|
| Rate for Payer: United Healthcare All Payer |
$2,721.84
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
OP
|
$2,893.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
340T0036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$994.90 |
| Max. Negotiated Rate |
$2,777.28 |
| Rate for Payer: Aetna Commercial |
$2,227.61
|
| Rate for Payer: Anthem Medicaid |
$994.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,256.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$1,446.50
|
| Rate for Payer: Cash Price |
$1,446.50
|
| Rate for Payer: Cigna Commercial |
$2,401.19
|
| Rate for Payer: First Health Commercial |
$2,748.35
|
| Rate for Payer: Humana Commercial |
$2,459.05
|
| Rate for Payer: Humana KY Medicaid |
$994.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,005.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,372.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,135.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,014.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,545.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,169.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,996.17
|
| Rate for Payer: PHCS Commercial |
$2,777.28
|
| Rate for Payer: United Healthcare All Payer |
$2,545.84
|
|
|
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: Ambetter Exchange |
$302.26
|
| Rate for Payer: Anthem Medicaid |
$291.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.71
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$302.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.26
|
| 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 |
$392.94
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.26
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Professional
|
Both
|
$3,093.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
34000036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$1,855.80 |
| Rate for Payer: Aetna Commercial |
$529.18
|
| Rate for Payer: Ambetter Exchange |
$302.26
|
| Rate for Payer: Anthem Medicaid |
$291.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.71
|
| Rate for Payer: Cash Price |
$1,546.50
|
| Rate for Payer: Cash Price |
$1,546.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$302.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.74
|
| Rate for Payer: Molina Healthcare Passport |
$291.90
|
| Rate for Payer: Multiplan PHCS |
$1,855.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.94
|
| Rate for Payer: UHCCP Medicaid |
$1,082.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.26
|
|
|
RADIOPHARM LOC OF TUMOR; SPECT
|
Facility
|
IP
|
$2,893.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
340T0036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$867.90 |
| Max. Negotiated Rate |
$2,777.28 |
| Rate for Payer: Aetna Commercial |
$2,227.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,256.54
|
| Rate for Payer: Cash Price |
$1,446.50
|
| Rate for Payer: Cigna Commercial |
$2,401.19
|
| Rate for Payer: First Health Commercial |
$2,748.35
|
| Rate for Payer: Humana Commercial |
$2,459.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,372.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,135.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,545.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,169.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,996.17
|
| Rate for Payer: PHCS Commercial |
$2,777.28
|
| Rate for Payer: United Healthcare All Payer |
$2,545.84
|
|
|
RADIO PHARM OF TUMOR
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
RADIO PHARM OF TUMOR
|
Professional
|
Both
|
$1,790.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$1,074.00 |
| Rate for Payer: Aetna Commercial |
$833.66
|
| Rate for Payer: Ambetter Exchange |
$506.98
|
| Rate for Payer: Anthem Medicaid |
$492.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$506.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$506.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$608.38
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$742.07
|
| Rate for Payer: Healthspan PPO |
$833.23
|
| Rate for Payer: Humana Medicaid |
$492.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$506.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.47
|
| Rate for Payer: Molina Healthcare Passport |
$492.62
|
| Rate for Payer: Multiplan PHCS |
$1,074.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$659.07
|
| Rate for Payer: UHCCP Medicaid |
$626.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$506.98
|
|
|
RADIO PHARM OF TUMOR
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$615.58 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem Medicaid |
$615.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Humana KY Medicaid |
$615.58
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$621.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
RADIO PHARM OF TUMOR(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340P0116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$833.66 |
| Rate for Payer: Aetna Commercial |
$833.66
|
| Rate for Payer: Ambetter Exchange |
$506.98
|
| Rate for Payer: Anthem Medicaid |
$492.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$506.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$506.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$608.38
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$742.07
|
| Rate for Payer: Healthspan PPO |
$833.23
|
| Rate for Payer: Humana Medicaid |
$492.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$506.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.47
|
| Rate for Payer: Molina Healthcare Passport |
$492.62
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$659.07
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$506.98
|
|
|
RADIO PHARM OF TUMOR(T
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340T0116
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$591.51 |
| Max. Negotiated Rate |
$1,688.74 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem Medicaid |
$591.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Humana KY Medicaid |
$591.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$597.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.80
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
