|
PRQ CARD STENT/ATH/ANGIO(T
|
Facility
|
IP
|
$12,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
761T2460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,566.82 |
| Max. Negotiated Rate |
$11,570.40 |
| Rate for Payer: Aetna Commercial |
$9,280.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,400.95
|
| Rate for Payer: Cash Price |
$6,026.25
|
| Rate for Payer: Cigna Commercial |
$10,003.58
|
| Rate for Payer: First Health Commercial |
$11,449.88
|
| Rate for Payer: Humana Commercial |
$10,244.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,883.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,894.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,615.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,606.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,039.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,736.28
|
| Rate for Payer: PHCS Commercial |
$11,570.40
|
| Rate for Payer: United Healthcare All Payer |
$10,606.20
|
|
|
PRQ CARD STENT/ATH/ANGIO(T
|
Facility
|
OP
|
$12,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
761T2460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,566.82 |
| Max. Negotiated Rate |
$11,570.40 |
| Rate for Payer: Aetna Commercial |
$9,280.42
|
| Rate for Payer: Anthem Medicaid |
$4,144.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,400.95
|
| Rate for Payer: Cash Price |
$6,026.25
|
| Rate for Payer: Cigna Commercial |
$10,003.58
|
| Rate for Payer: First Health Commercial |
$11,449.88
|
| Rate for Payer: Humana Commercial |
$10,244.62
|
| Rate for Payer: Humana KY Medicaid |
$4,144.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,187.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,883.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,894.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,615.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,606.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,039.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,736.28
|
| Rate for Payer: PHCS Commercial |
$11,570.40
|
| Rate for Payer: United Healthcare All Payer |
$10,606.20
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Professional
|
Both
|
$20,109.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
76102457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.06 |
| Max. Negotiated Rate |
$20,109.88 |
| Rate for Payer: Anthem Medicaid |
$483.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$20,109.88
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: Healthspan PPO |
$711.33
|
| Rate for Payer: Humana Medicaid |
$483.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.72
|
| Rate for Payer: Molina Healthcare Passport |
$483.06
|
| Rate for Payer: Multiplan PHCS |
$12,065.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14,076.92
|
| Rate for Payer: UHCCP Medicaid |
$7,038.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.89
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
OP
|
$20,109.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
76102457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,614.28 |
| Max. Negotiated Rate |
$19,305.48 |
| Rate for Payer: Aetna Commercial |
$15,484.61
|
| Rate for Payer: Anthem Medicaid |
$6,915.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,685.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cigna Commercial |
$16,691.20
|
| Rate for Payer: First Health Commercial |
$19,104.39
|
| Rate for Payer: Humana Commercial |
$17,093.40
|
| Rate for Payer: Humana KY Medicaid |
$6,915.79
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,986.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,490.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,841.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,054.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,696.69
|
| Rate for Payer: Ohio Health Group HMO |
$15,082.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,021.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,234.06
|
| Rate for Payer: PHCS Commercial |
$19,305.48
|
| Rate for Payer: United Healthcare All Payer |
$17,696.69
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
OP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
48100048
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem Medicaid |
$5,688.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Humana KY Medicaid |
$5,688.11
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,802.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
IP
|
$20,109.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
76102457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,614.28 |
| Max. Negotiated Rate |
$19,305.48 |
| Rate for Payer: Aetna Commercial |
$15,484.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,685.71
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cigna Commercial |
$16,691.20
|
| Rate for Payer: First Health Commercial |
$19,104.39
|
| Rate for Payer: Humana Commercial |
$17,093.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,490.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,841.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,032.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,696.69
|
| Rate for Payer: Ohio Health Group HMO |
$15,082.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,021.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,234.06
|
| Rate for Payer: PHCS Commercial |
$19,305.48
|
| Rate for Payer: United Healthcare All Payer |
$17,696.69
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
IP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
48100048
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ CARD STENT W/ANGIO 1 VS(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
761P2457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.50 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Anthem Medicaid |
$483.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: Healthspan PPO |
$711.33
|
| Rate for Payer: Humana Medicaid |
$483.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.72
|
| Rate for Payer: Molina Healthcare Passport |
$483.06
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.89
|
|
|
PRQ CARD STENT W/ANGIO 1 VS(T
|
Facility
|
IP
|
$18,959.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
761T2457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,464.78 |
| Max. Negotiated Rate |
$18,201.48 |
| Rate for Payer: Aetna Commercial |
$14,599.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,788.71
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cigna Commercial |
$15,736.70
|
| Rate for Payer: First Health Commercial |
$18,011.89
|
| Rate for Payer: Humana Commercial |
$16,115.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,547.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,992.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,687.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,684.69
|
| Rate for Payer: Ohio Health Group HMO |
$14,219.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,791.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,464.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,877.56
|
| Rate for Payer: PHCS Commercial |
$18,201.48
|
| Rate for Payer: United Healthcare All Payer |
$16,684.69
|
|
|
PRQ CARD STENT W/ANGIO 1 VS(T
|
Facility
|
OP
|
$18,959.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
761T2457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,464.78 |
| Max. Negotiated Rate |
$18,201.48 |
| Rate for Payer: Aetna Commercial |
$14,599.11
|
| Rate for Payer: Anthem Medicaid |
$6,520.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,788.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cigna Commercial |
$15,736.70
|
| Rate for Payer: First Health Commercial |
$18,011.89
|
| Rate for Payer: Humana Commercial |
$16,115.90
|
| Rate for Payer: Humana KY Medicaid |
$6,520.30
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,586.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,547.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,992.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,651.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,684.69
|
| Rate for Payer: Ohio Health Group HMO |
$14,219.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,791.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,464.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,877.56
|
| Rate for Payer: PHCS Commercial |
$18,201.48
|
| Rate for Payer: United Healthcare All Payer |
$16,684.69
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
IP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
48100049
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
OP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
48100049
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem Medicaid |
$5,688.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Humana KY Medicaid |
$5,688.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,802.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Professional
|
Both
|
$15,829.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
76102458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$15,829.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$15,829.00
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$9,497.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,080.30
|
| Rate for Payer: UHCCP Medicaid |
$5,540.15
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
OP
|
$15,829.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
76102458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,057.77 |
| Max. Negotiated Rate |
$15,195.84 |
| Rate for Payer: Aetna Commercial |
$12,188.33
|
| Rate for Payer: Anthem Medicaid |
$5,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.62
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Cigna Commercial |
$13,138.07
|
| Rate for Payer: First Health Commercial |
$15,037.55
|
| Rate for Payer: Humana Commercial |
$13,454.65
|
| Rate for Payer: Humana KY Medicaid |
$5,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,165.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,057.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.99
|
| Rate for Payer: PHCS Commercial |
$15,195.84
|
| Rate for Payer: United Healthcare All Payer |
$13,929.52
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
IP
|
$15,829.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
76102458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,057.77 |
| Max. Negotiated Rate |
$15,195.84 |
| Rate for Payer: Aetna Commercial |
$12,188.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.62
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Cigna Commercial |
$13,138.07
|
| Rate for Payer: First Health Commercial |
$15,037.55
|
| Rate for Payer: Humana Commercial |
$13,454.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,165.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,057.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,906.99
|
| Rate for Payer: PHCS Commercial |
$15,195.84
|
| Rate for Payer: United Healthcare All Payer |
$13,929.52
|
|
|
PRQ CARD STENT W/ANGIO ADDL(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
761P2458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
PRQ CARD STENT W/ANGIO ADDL(T
|
Facility
|
IP
|
$13,629.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
761T2458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,771.77 |
| Max. Negotiated Rate |
$13,083.84 |
| Rate for Payer: Aetna Commercial |
$10,494.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,630.62
|
| Rate for Payer: Cash Price |
$6,814.50
|
| Rate for Payer: Cigna Commercial |
$11,312.07
|
| Rate for Payer: First Health Commercial |
$12,947.55
|
| Rate for Payer: Humana Commercial |
$11,584.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,175.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,058.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,993.52
|
| Rate for Payer: Ohio Health Group HMO |
$10,221.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,771.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,224.99
|
| Rate for Payer: PHCS Commercial |
$13,083.84
|
| Rate for Payer: United Healthcare All Payer |
$11,993.52
|
|
|
PRQ CARD STENT W/ANGIO ADDL(T
|
Facility
|
OP
|
$13,629.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
761T2458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,771.77 |
| Max. Negotiated Rate |
$13,083.84 |
| Rate for Payer: Aetna Commercial |
$10,494.33
|
| Rate for Payer: Anthem Medicaid |
$4,687.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,630.62
|
| Rate for Payer: Cash Price |
$6,814.50
|
| Rate for Payer: Cigna Commercial |
$11,312.07
|
| Rate for Payer: First Health Commercial |
$12,947.55
|
| Rate for Payer: Humana Commercial |
$11,584.65
|
| Rate for Payer: Humana KY Medicaid |
$4,687.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,734.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,175.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,058.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,781.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,993.52
|
| Rate for Payer: Ohio Health Group HMO |
$10,221.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,771.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,224.99
|
| Rate for Payer: PHCS Commercial |
$13,083.84
|
| Rate for Payer: United Healthcare All Payer |
$11,993.52
|
|
|
PRQ REVASC BYP GRAFT 1 VSL
|
Facility
|
OP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
48100052
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem Medicaid |
$5,688.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Humana KY Medicaid |
$5,688.11
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,802.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ REVASC BYP GRAFT 1 VSL
|
Facility
|
IP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
48100052
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ REVASC BYP GRAFT 1 VSL
|
Facility
|
OP
|
$20,108.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
76102461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,614.04 |
| Max. Negotiated Rate |
$19,303.68 |
| Rate for Payer: Aetna Commercial |
$15,483.16
|
| Rate for Payer: Anthem Medicaid |
$6,915.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,684.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$10,054.00
|
| Rate for Payer: Cash Price |
$10,054.00
|
| Rate for Payer: Cigna Commercial |
$16,689.64
|
| Rate for Payer: First Health Commercial |
$19,102.60
|
| Rate for Payer: Humana Commercial |
$17,091.80
|
| Rate for Payer: Humana KY Medicaid |
$6,915.14
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,985.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,488.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,839.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,053.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,695.04
|
| Rate for Payer: Ohio Health Group HMO |
$15,081.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,233.48
|
| Rate for Payer: PHCS Commercial |
$19,303.68
|
| Rate for Payer: United Healthcare All Payer |
$17,695.04
|
|
|
PRQ REVASC BYP GRAFT 1 VSL
|
Professional
|
Both
|
$20,108.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
76102461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.77 |
| Max. Negotiated Rate |
$20,108.00 |
| Rate for Payer: Anthem Medicaid |
$482.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$20,108.00
|
| Rate for Payer: Cash Price |
$10,054.00
|
| Rate for Payer: Cash Price |
$10,054.00
|
| Rate for Payer: Cigna Commercial |
$1,072.36
|
| Rate for Payer: Healthspan PPO |
$710.94
|
| Rate for Payer: Humana Medicaid |
$482.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$766.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.43
|
| Rate for Payer: Molina Healthcare Passport |
$482.77
|
| Rate for Payer: Multiplan PHCS |
$12,064.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14,075.60
|
| Rate for Payer: UHCCP Medicaid |
$7,037.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.60
|
|
|
PRQ REVASC BYP GRAFT 1 VSL
|
Facility
|
IP
|
$20,108.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
76102461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,614.04 |
| Max. Negotiated Rate |
$19,303.68 |
| Rate for Payer: Aetna Commercial |
$15,483.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,684.24
|
| Rate for Payer: Cash Price |
$10,054.00
|
| Rate for Payer: Cigna Commercial |
$16,689.64
|
| Rate for Payer: First Health Commercial |
$19,102.60
|
| Rate for Payer: Humana Commercial |
$17,091.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,488.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,839.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,032.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,695.04
|
| Rate for Payer: Ohio Health Group HMO |
$15,081.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,614.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,233.48
|
| Rate for Payer: PHCS Commercial |
$19,303.68
|
| Rate for Payer: United Healthcare All Payer |
$17,695.04
|
|
|
PRQ REVASC BYP GRAFT 1 VSL(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
761P2461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.50 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Anthem Medicaid |
$482.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$1,072.36
|
| Rate for Payer: Healthspan PPO |
$710.94
|
| Rate for Payer: Humana Medicaid |
$482.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$766.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.43
|
| Rate for Payer: Molina Healthcare Passport |
$482.77
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.60
|
|
|
PRQ REVASC BYP GRAFT 1 VSL(T
|
Facility
|
IP
|
$18,958.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
761T2461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$18,199.68 |
| Rate for Payer: Aetna Commercial |
$14,597.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,787.24
|
| Rate for Payer: Cash Price |
$9,479.00
|
| Rate for Payer: Cigna Commercial |
$15,735.14
|
| Rate for Payer: First Health Commercial |
$18,010.10
|
| Rate for Payer: Humana Commercial |
$16,114.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,545.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,991.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,687.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,683.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,218.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,791.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,464.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,876.98
|
| Rate for Payer: PHCS Commercial |
$18,199.68
|
| Rate for Payer: United Healthcare All Payer |
$16,683.04
|
|
