|
PRQ REVASC BYP GRAFT 1 VSL(T
|
Facility
|
OP
|
$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 Medicaid |
$6,519.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,787.24
|
| 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 |
$9,479.00
|
| 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: Humana KY Medicaid |
$6,519.66
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,586.01
|
| 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 |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,650.47
|
| 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
|
|
|
PRQ REVASC BYP GRAFT ADDL
|
Facility
|
OP
|
$15,716.48
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
76102462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,043.14 |
| Max. Negotiated Rate |
$15,087.82 |
| Rate for Payer: Aetna Commercial |
$12,101.69
|
| Rate for Payer: Anthem Medicaid |
$5,404.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,258.85
|
| Rate for Payer: Cash Price |
$7,858.24
|
| Rate for Payer: Cigna Commercial |
$13,044.68
|
| Rate for Payer: First Health Commercial |
$14,930.66
|
| Rate for Payer: Humana Commercial |
$13,359.01
|
| Rate for Payer: Humana KY Medicaid |
$5,404.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,459.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,887.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,598.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,714.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,513.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,830.50
|
| Rate for Payer: Ohio Health Group HMO |
$11,787.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,143.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,872.11
|
| Rate for Payer: PHCS Commercial |
$15,087.82
|
| Rate for Payer: United Healthcare All Payer |
$13,830.50
|
|
|
PRQ REVASC BYP GRAFT ADDL
|
Facility
|
IP
|
$15,716.48
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
76102462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,043.14 |
| Max. Negotiated Rate |
$15,087.82 |
| Rate for Payer: Aetna Commercial |
$12,101.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,258.85
|
| Rate for Payer: Cash Price |
$7,858.24
|
| Rate for Payer: Cigna Commercial |
$13,044.68
|
| Rate for Payer: First Health Commercial |
$14,930.66
|
| Rate for Payer: Humana Commercial |
$13,359.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,887.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,598.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,714.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,830.50
|
| Rate for Payer: Ohio Health Group HMO |
$11,787.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,143.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,872.11
|
| Rate for Payer: PHCS Commercial |
$15,087.82
|
| Rate for Payer: United Healthcare All Payer |
$13,830.50
|
|
|
PRQ REVASC BYP GRAFT ADDL
|
Facility
|
IP
|
$15,678.00
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,038.14 |
| Max. Negotiated Rate |
$15,050.88 |
| Rate for Payer: Aetna Commercial |
$12,072.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,228.84
|
| Rate for Payer: Cash Price |
$7,839.00
|
| Rate for Payer: Cigna Commercial |
$13,012.74
|
| Rate for Payer: First Health Commercial |
$14,894.10
|
| Rate for Payer: Humana Commercial |
$13,326.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,855.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,570.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,703.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,796.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,758.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,135.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,038.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,860.18
|
| Rate for Payer: PHCS Commercial |
$15,050.88
|
| Rate for Payer: United Healthcare All Payer |
$13,796.64
|
|
|
PRQ REVASC BYP GRAFT ADDL
|
Professional
|
Both
|
$15,716.48
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
76102462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$15,716.48 |
| Rate for Payer: Buckeye Medicare Advantage |
$15,716.48
|
| Rate for Payer: Cash Price |
$7,858.24
|
| Rate for Payer: Cash Price |
$7,858.24
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$9,429.89
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,001.54
|
| Rate for Payer: UHCCP Medicaid |
$5,500.77
|
|
|
PRQ REVASC BYP GRAFT ADDL
|
Facility
|
OP
|
$15,678.00
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,038.14 |
| Max. Negotiated Rate |
$15,050.88 |
| Rate for Payer: Aetna Commercial |
$12,072.06
|
| Rate for Payer: Anthem Medicaid |
$5,391.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,228.84
|
| Rate for Payer: Cash Price |
$7,839.00
|
| Rate for Payer: Cigna Commercial |
$13,012.74
|
| Rate for Payer: First Health Commercial |
$14,894.10
|
| Rate for Payer: Humana Commercial |
$13,326.30
|
| Rate for Payer: Humana KY Medicaid |
$5,391.66
|
| Rate for Payer: Kentucky WC Medicaid |
$5,446.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,855.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,570.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,703.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,499.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,796.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,758.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,135.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,038.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,860.18
|
| Rate for Payer: PHCS Commercial |
$15,050.88
|
| Rate for Payer: United Healthcare All Payer |
$13,796.64
|
|
|
PRQ REVASC BYP GRAFT ADDL(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
761P2462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,475.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.50
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
|
|
PRQ REVASC BYP GRAFT ADDL(T
|
Facility
|
OP
|
$14,241.48
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
761T2462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,851.39 |
| Max. Negotiated Rate |
$13,671.82 |
| Rate for Payer: Aetna Commercial |
$10,965.94
|
| Rate for Payer: Anthem Medicaid |
$4,897.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,108.35
|
| Rate for Payer: Cash Price |
$7,120.74
|
| Rate for Payer: Cigna Commercial |
$11,820.43
|
| Rate for Payer: First Health Commercial |
$13,529.41
|
| Rate for Payer: Humana Commercial |
$12,105.26
|
| Rate for Payer: Humana KY Medicaid |
$4,897.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,947.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,678.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,510.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,272.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,995.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,532.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,681.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,848.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,414.86
|
| Rate for Payer: PHCS Commercial |
$13,671.82
|
| Rate for Payer: United Healthcare All Payer |
$12,532.50
|
|
|
PRQ REVASC BYP GRAFT ADDL(T
|
Facility
|
IP
|
$14,241.48
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
761T2462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,851.39 |
| Max. Negotiated Rate |
$13,671.82 |
| Rate for Payer: Aetna Commercial |
$10,965.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,108.35
|
| Rate for Payer: Cash Price |
$7,120.74
|
| Rate for Payer: Cigna Commercial |
$11,820.43
|
| Rate for Payer: First Health Commercial |
$13,529.41
|
| Rate for Payer: Humana Commercial |
$12,105.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,678.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,510.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,272.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,532.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,681.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,848.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,414.86
|
| Rate for Payer: PHCS Commercial |
$13,671.82
|
| Rate for Payer: United Healthcare All Payer |
$12,532.50
|
|
|
PRQ SKELETAL FIXJ CALCANEAL FX
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 28406
|
| Hospital Charge Code |
76101012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
PRQ SKELETAL FIXJ CALCANEAL FX
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 28406
|
| Hospital Charge Code |
76101012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
PRQ SKELETAL FIXJ CALCANEAL FX
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 28406
|
| Hospital Charge Code |
761P1012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$863.97 |
| Rate for Payer: Aetna Commercial |
$768.15
|
| Rate for Payer: Anthem Medicaid |
$356.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$715.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$863.97
|
| Rate for Payer: Healthspan PPO |
$695.78
|
| Rate for Payer: Humana Medicaid |
$356.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$646.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$363.85
|
| Rate for Payer: Molina Healthcare Passport |
$356.72
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.50
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$360.29
|
|
|
PRQ SKELETAL FIXJ CALCANEAL FX
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 28406
|
| Hospital Charge Code |
76101012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$863.97 |
| Rate for Payer: Aetna Commercial |
$768.15
|
| Rate for Payer: Anthem Medicaid |
$356.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$715.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$863.97
|
| Rate for Payer: Healthspan PPO |
$695.78
|
| Rate for Payer: Humana Medicaid |
$356.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$646.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$363.85
|
| Rate for Payer: Molina Healthcare Passport |
$356.72
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.50
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$360.29
|
|
|
PRQ SKEL FIXJ METAR FX
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
76101021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.95
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
PRQ SKEL FIXJ METAR FX
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
76101021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem Medicaid |
$187.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Humana KY Medicaid |
$187.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$189.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.95
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
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 |
$545.00 |
| Rate for Payer: Aetna Commercial |
$480.63
|
| Rate for Payer: Anthem Medicaid |
$193.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.00
|
| 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: 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 |
$381.50
|
| Rate for Payer: UHCCP Medicaid |
$190.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.70
|
|
|
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 |
$545.00 |
| Rate for Payer: Aetna Commercial |
$480.63
|
| Rate for Payer: Anthem Medicaid |
$193.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.00
|
| 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: 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 |
$381.50
|
| Rate for Payer: UHCCP Medicaid |
$190.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.70
|
|
|
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 |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$767.91
|
| 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 Medicare Advantage |
$1,000.00
|
| 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: 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 |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$276.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.82
|
|
|
PRTAL EXC CRATERIZATION METATA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
76100987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| 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 |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PRTAL EXC CRATERIZATION METATA
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28122
|
| Hospital Charge Code |
76100987
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| 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 |
$2,799.07
|
| 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 |
$3,358.88
|
| 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 |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| 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 |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$767.91
|
| 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 Medicare Advantage |
$1,000.00
|
| 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: 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 |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$276.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.82
|
|
|
PRUITT AORTIC OCCLUSIOM CATH
|
Facility
|
OP
|
$3,211.50
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.50 |
| Max. Negotiated Rate |
$3,083.04 |
| Rate for Payer: Aetna Commercial |
$2,472.86
|
| Rate for Payer: Anthem Medicaid |
$1,104.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.97
|
| Rate for Payer: Cash Price |
$1,605.75
|
| Rate for Payer: Cigna Commercial |
$2,665.54
|
| Rate for Payer: First Health Commercial |
$3,050.92
|
| Rate for Payer: Humana Commercial |
$2,729.78
|
| Rate for Payer: Humana KY Medicaid |
$1,104.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,633.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,370.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,126.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,826.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,408.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.56
|
| Rate for Payer: PHCS Commercial |
$3,083.04
|
| Rate for Payer: United Healthcare All Payer |
$2,826.12
|
|
|
PRUITT AORTIC OCCLUSIOM CATH
|
Facility
|
IP
|
$3,211.50
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.50 |
| Max. Negotiated Rate |
$3,083.04 |
| Rate for Payer: Aetna Commercial |
$2,472.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.97
|
| Rate for Payer: Cash Price |
$1,605.75
|
| Rate for Payer: Cigna Commercial |
$2,665.54
|
| Rate for Payer: First Health Commercial |
$3,050.92
|
| Rate for Payer: Humana Commercial |
$2,729.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,633.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,370.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,826.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,408.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.56
|
| Rate for Payer: PHCS Commercial |
$3,083.04
|
| Rate for Payer: United Healthcare All Payer |
$2,826.12
|
|
|
PSA DIAGNOSTIC
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
PSA DIAGNOSTIC
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Healthspan PPO |
$33.00
|
| Rate for Payer: Multiplan PHCS |
$58.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.60
|
| Rate for Payer: UHCCP Medicaid |
$34.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
|
