|
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 |
$1,540.00 |
| 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
|
OP
|
$13,629.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
761T2458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,088.70 |
| 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 |
$10,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,857.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,404.01
|
| 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
|
IP
|
$13,629.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
761T2458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,088.70 |
| 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 |
$10,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,857.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,404.01
|
| 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
|
IP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
48100052
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,284.50 |
| Max. Negotiated Rate |
$16,910.40 |
| Rate for Payer: Aetna Commercial |
$13,563.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,739.70
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cigna Commercial |
$14,620.45
|
| Rate for Payer: First Health Commercial |
$16,734.25
|
| Rate for Payer: Humana Commercial |
$14,972.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,999.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,284.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,501.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,211.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,325.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,154.35
|
| Rate for Payer: PHCS Commercial |
$16,910.40
|
| Rate for Payer: United Healthcare All Payer |
$15,501.20
|
|
|
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 |
$6,915.14 |
| 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 |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,684.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$16,086.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,493.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,874.52
|
| 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 |
$12,064.80 |
| Rate for Payer: Ambetter Exchange |
$548.04
|
| Rate for Payer: Anthem Medicaid |
$482.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$657.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$548.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.04
|
| 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 |
$712.45
|
| Rate for Payer: UHCCP Medicaid |
$7,037.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.04
|
|
|
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 |
$6,032.40 |
| 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 |
$16,086.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,493.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,874.52
|
| Rate for Payer: PHCS Commercial |
$19,303.68
|
| Rate for Payer: United Healthcare All Payer |
$17,695.04
|
|
|
PRQ REVASC BYP GRAFT 1 VSL
|
Facility
|
OP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92937
|
| Hospital Charge Code |
48100052
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,057.80 |
| Max. Negotiated Rate |
$16,910.40 |
| Rate for Payer: Aetna Commercial |
$13,563.55
|
| Rate for Payer: Anthem Medicaid |
$6,057.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,739.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cigna Commercial |
$14,620.45
|
| Rate for Payer: First Health Commercial |
$16,734.25
|
| Rate for Payer: Humana Commercial |
$14,972.75
|
| Rate for Payer: Humana KY Medicaid |
$6,057.80
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$6,119.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,999.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,179.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,501.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,211.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,325.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,154.35
|
| Rate for Payer: PHCS Commercial |
$16,910.40
|
| Rate for Payer: United Healthcare All Payer |
$15,501.20
|
|
|
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 |
$1,072.36 |
| Rate for Payer: Ambetter Exchange |
$548.04
|
| Rate for Payer: Anthem Medicaid |
$482.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$657.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$548.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.04
|
| 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 |
$712.45
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.04
|
|
|
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 |
$6,519.66 |
| 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 |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,787.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$15,166.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,493.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,081.02
|
| Rate for Payer: PHCS Commercial |
$18,199.68
|
| Rate for Payer: United Healthcare All Payer |
$16,683.04
|
|
|
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 |
$5,687.40 |
| 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 |
$15,166.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,493.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,081.02
|
| 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
|
$15,678.00
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,703.40 |
| 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 |
$12,542.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,639.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,817.82
|
| Rate for Payer: PHCS Commercial |
$15,050.88
|
| Rate for Payer: United Healthcare All Payer |
$13,796.64
|
|
|
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 |
$4,714.94 |
| 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 |
$12,573.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,673.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,844.37
|
| 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 |
$4,714.94 |
| 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 |
$12,573.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,673.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,844.37
|
| Rate for Payer: PHCS Commercial |
$15,087.82
|
| Rate for Payer: United Healthcare All Payer |
$13,830.50
|
|
|
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 |
$11,001.54 |
| 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
|
IP
|
$15,678.00
|
|
|
Service Code
|
HCPCS 92938
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,703.40 |
| 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 |
$12,542.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,639.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,817.82
|
| 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 |
$1,032.50 |
| 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 |
$4,272.44 |
| 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 |
$11,393.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,390.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,826.62
|
| 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 |
$4,272.44 |
| 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 |
$11,393.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,390.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,826.62
|
| Rate for Payer: PHCS Commercial |
$13,671.82
|
| Rate for Payer: United Healthcare All Payer |
$12,532.50
|
|
|
PRQ SKELETAL FIXJ CALCANEAL FX
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 28406
|
| Hospital Charge Code |
76101012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.89 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
PRQ SKELETAL FIXJ CALCANEAL FX
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 28406
|
| Hospital Charge Code |
76101012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| 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 |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| 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 |
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: Ambetter Exchange |
$559.64
|
| Rate for Payer: Anthem Medicaid |
$356.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$559.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$559.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.57
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$559.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.64
|
| 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 |
$727.53
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$360.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$559.64
|
|
|
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: Ambetter Exchange |
$559.64
|
| Rate for Payer: Anthem Medicaid |
$356.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$559.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$559.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.57
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$559.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.64
|
| 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 |
$727.53
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$360.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$559.64
|
|
|
PRQ SKEL FIXJ METAR FX
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
76101021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.43 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem Medicaid |
$187.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
PRQ SKEL FIXJ METAR FX
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 28476
|
| Hospital Charge Code |
76101021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.50 |
| 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 |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
