|
PRQ SKEL FIXJ METAR FX
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
76101021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$543.22 |
| Rate for Payer: Aetna Commercial |
$480.63
|
| Rate for Payer: Ambetter Exchange |
$367.44
|
| Rate for Payer: Anthem Medicaid |
$193.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.93
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$543.22
|
| Rate for Payer: Healthspan PPO |
$435.35
|
| Rate for Payer: Humana Medicaid |
$193.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$416.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.64
|
| Rate for Payer: Molina Healthcare Passport |
$193.76
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.67
|
| Rate for Payer: UHCCP Medicaid |
$190.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.44
|
|
|
PRQ SKEL FIXJ METAR FX (P
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
761P1021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$543.22 |
| Rate for Payer: Aetna Commercial |
$480.63
|
| Rate for Payer: Ambetter Exchange |
$367.44
|
| Rate for Payer: Anthem Medicaid |
$193.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.93
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$543.22
|
| Rate for Payer: Healthspan PPO |
$435.35
|
| Rate for Payer: Humana Medicaid |
$193.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$416.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.64
|
| Rate for Payer: Molina Healthcare Passport |
$193.76
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.67
|
| Rate for Payer: UHCCP Medicaid |
$190.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.44
|
|
|
PRQ TCAT THER RX NTRAC BALO1
|
Facility
|
OP
|
$13,540.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Hospital Charge Code |
48000117
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,656.41 |
| Max. Negotiated Rate |
$12,998.40 |
| Rate for Payer: Aetna Commercial |
$10,425.80
|
| Rate for Payer: Anthem Medicaid |
$4,656.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,561.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$6,770.00
|
| Rate for Payer: Cash Price |
$6,770.00
|
| Rate for Payer: Cigna Commercial |
$11,238.20
|
| Rate for Payer: First Health Commercial |
$12,863.00
|
| Rate for Payer: Humana Commercial |
$11,509.00
|
| Rate for Payer: Humana KY Medicaid |
$4,656.41
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,703.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,102.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,992.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,749.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,915.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,155.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,779.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,342.60
|
| Rate for Payer: PHCS Commercial |
$12,998.40
|
| Rate for Payer: United Healthcare All Payer |
$11,915.20
|
|
|
PRQ TCAT THER RX NTRAC BALO1
|
Facility
|
IP
|
$13,540.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Hospital Charge Code |
48000117
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,062.00 |
| Max. Negotiated Rate |
$12,998.40 |
| Rate for Payer: Aetna Commercial |
$10,425.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,561.20
|
| Rate for Payer: Cash Price |
$6,770.00
|
| Rate for Payer: Cigna Commercial |
$11,238.20
|
| Rate for Payer: First Health Commercial |
$12,863.00
|
| Rate for Payer: Humana Commercial |
$11,509.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,102.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,992.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,062.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,915.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,155.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,779.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,342.60
|
| Rate for Payer: PHCS Commercial |
$12,998.40
|
| Rate for Payer: United Healthcare All Payer |
$11,915.20
|
|
|
PRQ TCAT THER RX NTRAC BALO1
|
Professional
|
Both
|
$13,540.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Hospital Charge Code |
48000117
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,739.00 |
| Max. Negotiated Rate |
$9,478.00 |
| Rate for Payer: Cash Price |
$6,770.00
|
| Rate for Payer: Multiplan PHCS |
$8,124.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9,478.00
|
| Rate for Payer: UHCCP Medicaid |
$4,739.00
|
|
|
PRQ TCAT THER RX NTRAC BALO1(P
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Hospital Charge Code |
480P0117
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$2,187.50 |
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Multiplan PHCS |
$1,875.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,187.50
|
| Rate for Payer: UHCCP Medicaid |
$1,093.75
|
|
|
PRQ TCAT THER RX NTRAC BALO1(T
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Hospital Charge Code |
480T0117
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,581.72 |
| Max. Negotiated Rate |
$9,998.40 |
| Rate for Payer: Aetna Commercial |
$8,019.55
|
| Rate for Payer: Anthem Medicaid |
$3,581.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,123.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$5,207.50
|
| Rate for Payer: Cash Price |
$5,207.50
|
| Rate for Payer: Cigna Commercial |
$8,644.45
|
| Rate for Payer: First Health Commercial |
$9,894.25
|
| Rate for Payer: Humana Commercial |
$8,852.75
|
| Rate for Payer: Humana KY Medicaid |
$3,581.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,618.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,540.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,686.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,653.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,165.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,061.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,186.35
|
| Rate for Payer: PHCS Commercial |
$9,998.40
|
| Rate for Payer: United Healthcare All Payer |
$9,165.20
|
|
|
PRQ TCAT THER RX NTRAC BALO1(T
|
Facility
|
IP
|
$10,415.00
|
|
|
Service Code
|
HCPCS 0913T
|
| Hospital Charge Code |
480T0117
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,124.50 |
| Max. Negotiated Rate |
$9,998.40 |
| Rate for Payer: Aetna Commercial |
$8,019.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,123.70
|
| Rate for Payer: Cash Price |
$5,207.50
|
| Rate for Payer: Cigna Commercial |
$8,644.45
|
| Rate for Payer: First Health Commercial |
$9,894.25
|
| Rate for Payer: Humana Commercial |
$8,852.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,540.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,686.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,124.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,165.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,061.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,186.35
|
| Rate for Payer: PHCS Commercial |
$9,998.40
|
| Rate for Payer: United Healthcare All Payer |
$9,165.20
|
|
|
PRQ TCAT THR RX NTRC BAL SEP
|
Facility
|
OP
|
$8,335.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Hospital Charge Code |
48000118
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,500.50 |
| Max. Negotiated Rate |
$8,001.60 |
| Rate for Payer: Aetna Commercial |
$6,417.95
|
| Rate for Payer: Anthem Medicaid |
$2,866.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,501.30
|
| Rate for Payer: Cash Price |
$4,167.50
|
| Rate for Payer: Cigna Commercial |
$6,918.05
|
| Rate for Payer: First Health Commercial |
$7,918.25
|
| Rate for Payer: Humana Commercial |
$7,084.75
|
| Rate for Payer: Humana KY Medicaid |
$2,866.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,895.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,834.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,151.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,500.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,923.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,334.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,251.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,751.15
|
| Rate for Payer: PHCS Commercial |
$8,001.60
|
| Rate for Payer: United Healthcare All Payer |
$7,334.80
|
|
|
PRQ TCAT THR RX NTRC BAL SEP
|
Professional
|
Both
|
$8,335.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Hospital Charge Code |
48000118
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,917.25 |
| Max. Negotiated Rate |
$5,834.50 |
| Rate for Payer: Cash Price |
$4,167.50
|
| Rate for Payer: Multiplan PHCS |
$5,001.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,834.50
|
| Rate for Payer: UHCCP Medicaid |
$2,917.25
|
|
|
PRQ TCAT THR RX NTRC BAL SEP
|
Facility
|
IP
|
$8,335.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Hospital Charge Code |
48000118
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,500.50 |
| Max. Negotiated Rate |
$8,001.60 |
| Rate for Payer: Aetna Commercial |
$6,417.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,501.30
|
| Rate for Payer: Cash Price |
$4,167.50
|
| Rate for Payer: Cigna Commercial |
$6,918.05
|
| Rate for Payer: First Health Commercial |
$7,918.25
|
| Rate for Payer: Humana Commercial |
$7,084.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,834.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,151.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,500.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,334.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,251.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,751.15
|
| Rate for Payer: PHCS Commercial |
$8,001.60
|
| Rate for Payer: United Healthcare All Payer |
$7,334.80
|
|
|
PRQ TCAT THR RX NTRC BAL SEP(P
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Hospital Charge Code |
480P0118
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$2,187.50 |
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Multiplan PHCS |
$1,875.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,187.50
|
| Rate for Payer: UHCCP Medicaid |
$1,093.75
|
|
|
PRQ TCAT THR RX NTRC BAL SEP(T
|
Facility
|
IP
|
$5,210.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Hospital Charge Code |
480T0118
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,532.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.90
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
PRQ TCAT THR RX NTRC BAL SEP(T
|
Facility
|
OP
|
$5,210.00
|
|
|
Service Code
|
HCPCS 0914T
|
| Hospital Charge Code |
480T0118
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem Medicaid |
$1,791.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Humana KY Medicaid |
$1,791.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,827.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,532.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.90
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
PRTAL EXC CRATERIZATION METATA
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
76100987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PRTAL EXC CRATERIZATION METATA
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
761P0987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$843.91 |
| Rate for Payer: Aetna Commercial |
$767.91
|
| Rate for Payer: Ambetter Exchange |
$417.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.86
|
| Rate for Payer: Anthem Medicaid |
$327.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$417.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$500.90
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$838.89
|
| Rate for Payer: Healthspan PPO |
$843.91
|
| Rate for Payer: Humana Medicaid |
$327.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$417.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.09
|
| Rate for Payer: Molina Healthcare Passport |
$327.54
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.65
|
| Rate for Payer: UHCCP Medicaid |
$276.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$417.42
|
|
|
PRTAL EXC CRATERIZATION METATA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
76100987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PRTAL EXC CRATERIZATION METATA
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
76100987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$843.91 |
| Rate for Payer: Aetna Commercial |
$767.91
|
| Rate for Payer: Ambetter Exchange |
$417.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.86
|
| Rate for Payer: Anthem Medicaid |
$327.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$417.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$500.90
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$838.89
|
| Rate for Payer: Healthspan PPO |
$843.91
|
| Rate for Payer: Humana Medicaid |
$327.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$417.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$334.09
|
| Rate for Payer: Molina Healthcare Passport |
$327.54
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.65
|
| Rate for Payer: UHCCP Medicaid |
$276.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$417.42
|
|
|
PRUITT AORTIC OCCLUSIOM CATH
|
Facility
|
OP
|
$3,083.75
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$925.12 |
| Max. Negotiated Rate |
$2,960.40 |
| Rate for Payer: Aetna Commercial |
$2,374.49
|
| Rate for Payer: Anthem Medicaid |
$1,060.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,405.32
|
| Rate for Payer: Cash Price |
$1,541.88
|
| Rate for Payer: Cigna Commercial |
$2,559.51
|
| Rate for Payer: First Health Commercial |
$2,929.56
|
| Rate for Payer: Humana Commercial |
$2,621.19
|
| Rate for Payer: Humana KY Medicaid |
$1,060.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,081.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,713.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.79
|
| Rate for Payer: PHCS Commercial |
$2,960.40
|
| Rate for Payer: United Healthcare All Payer |
$2,713.70
|
|
|
PRUITT AORTIC OCCLUSIOM CATH
|
Facility
|
IP
|
$3,083.75
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$925.12 |
| Max. Negotiated Rate |
$2,960.40 |
| Rate for Payer: Aetna Commercial |
$2,374.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,405.32
|
| Rate for Payer: Cash Price |
$1,541.88
|
| Rate for Payer: Cigna Commercial |
$2,559.51
|
| Rate for Payer: First Health Commercial |
$2,929.56
|
| Rate for Payer: Humana Commercial |
$2,621.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,528.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,713.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.79
|
| Rate for Payer: PHCS Commercial |
$2,960.40
|
| Rate for Payer: United Healthcare All Payer |
$2,713.70
|
|
|
PSA DIAGNOSTIC
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
PSA DIAGNOSTIC
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
PSA DIAGNOSTIC
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: Ambetter Exchange |
$18.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.07
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Healthspan PPO |
$33.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.39
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.91
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
|
|
PSA SCREEN
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.14
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
|
PSA SCREEN
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.14
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
