|
PRQ CARDIAC ANGIO ADDL ART
|
Facility
|
OP
|
$8,982.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
48100045
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,167.66 |
| Max. Negotiated Rate |
$8,622.72 |
| Rate for Payer: Aetna Commercial |
$6,916.14
|
| Rate for Payer: Anthem Medicaid |
$3,088.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,005.96
|
| Rate for Payer: Cash Price |
$4,491.00
|
| Rate for Payer: Cigna Commercial |
$7,455.06
|
| Rate for Payer: First Health Commercial |
$8,532.90
|
| Rate for Payer: Humana Commercial |
$7,634.70
|
| Rate for Payer: Humana KY Medicaid |
$3,088.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,120.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,365.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,628.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,694.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,150.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,904.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.42
|
| Rate for Payer: PHCS Commercial |
$8,622.72
|
| Rate for Payer: United Healthcare All Payer |
$7,904.16
|
|
|
PRQ CARDIAC ANGIO ADDL ART(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
761P2454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
|
|
PRQ CARDIAC ANGIO ADDL ART(T
|
Facility
|
OP
|
$10,007.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
761T2454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,300.91 |
| Max. Negotiated Rate |
$9,606.72 |
| Rate for Payer: Aetna Commercial |
$7,705.39
|
| Rate for Payer: Anthem Medicaid |
$3,441.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,805.46
|
| Rate for Payer: Cash Price |
$5,003.50
|
| Rate for Payer: Cigna Commercial |
$8,305.81
|
| Rate for Payer: First Health Commercial |
$9,506.65
|
| Rate for Payer: Humana Commercial |
$8,505.95
|
| Rate for Payer: Humana KY Medicaid |
$3,441.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,476.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,205.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,385.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,002.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,510.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,806.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,102.17
|
| Rate for Payer: PHCS Commercial |
$9,606.72
|
| Rate for Payer: United Healthcare All Payer |
$8,806.16
|
|
|
PRQ CARDIAC ANGIO ADDL ART(T
|
Facility
|
IP
|
$10,007.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
761T2454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,300.91 |
| Max. Negotiated Rate |
$9,606.72 |
| Rate for Payer: Aetna Commercial |
$7,705.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,805.46
|
| Rate for Payer: Cash Price |
$5,003.50
|
| Rate for Payer: Cigna Commercial |
$8,305.81
|
| Rate for Payer: First Health Commercial |
$9,506.65
|
| Rate for Payer: Humana Commercial |
$8,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,205.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,385.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,002.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,806.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,102.17
|
| Rate for Payer: PHCS Commercial |
$9,606.72
|
| Rate for Payer: United Healthcare All Payer |
$8,806.16
|
|
|
PRQ CARDIAC ANGIOPLAST 1 AR(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
761P2453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Anthem Medicaid |
$435.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$966.56
|
| Rate for Payer: Healthspan PPO |
$640.55
|
| Rate for Payer: Humana Medicaid |
$435.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$690.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.90
|
| Rate for Payer: Molina Healthcare Passport |
$435.20
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$439.55
|
|
|
PRQ CARDIAC ANGIOPLAST 1 AR(T
|
Facility
|
IP
|
$13,410.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
761T2453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,743.30 |
| Max. Negotiated Rate |
$12,873.60 |
| Rate for Payer: Aetna Commercial |
$10,325.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.80
|
| Rate for Payer: Cash Price |
$6,705.00
|
| Rate for Payer: Cigna Commercial |
$11,130.30
|
| Rate for Payer: First Health Commercial |
$12,739.50
|
| Rate for Payer: Humana Commercial |
$11,398.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,996.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,896.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,800.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,682.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,743.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,157.10
|
| Rate for Payer: PHCS Commercial |
$12,873.60
|
| Rate for Payer: United Healthcare All Payer |
$11,800.80
|
|
|
PRQ CARDIAC ANGIOPLAST 1 AR(T
|
Facility
|
OP
|
$13,410.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
761T2453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,743.30 |
| Max. Negotiated Rate |
$12,873.60 |
| Rate for Payer: Aetna Commercial |
$10,325.70
|
| Rate for Payer: Anthem Medicaid |
$4,611.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$6,705.00
|
| Rate for Payer: Cash Price |
$6,705.00
|
| Rate for Payer: Cigna Commercial |
$11,130.30
|
| Rate for Payer: First Health Commercial |
$12,739.50
|
| Rate for Payer: Humana Commercial |
$11,398.50
|
| Rate for Payer: Humana KY Medicaid |
$4,611.70
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,996.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,896.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,704.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,800.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,682.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,743.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,157.10
|
| Rate for Payer: PHCS Commercial |
$12,873.60
|
| Rate for Payer: United Healthcare All Payer |
$11,800.80
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
OP
|
$8,982.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,167.66 |
| Max. Negotiated Rate |
$8,622.72 |
| Rate for Payer: Aetna Commercial |
$6,916.14
|
| Rate for Payer: Anthem Medicaid |
$3,088.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,005.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$4,491.00
|
| Rate for Payer: Cash Price |
$4,491.00
|
| Rate for Payer: Cigna Commercial |
$7,455.06
|
| Rate for Payer: First Health Commercial |
$8,532.90
|
| Rate for Payer: Humana Commercial |
$7,634.70
|
| Rate for Payer: Humana KY Medicaid |
$3,088.91
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,120.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,365.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,628.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,150.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,904.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.42
|
| Rate for Payer: PHCS Commercial |
$8,622.72
|
| Rate for Payer: United Healthcare All Payer |
$7,904.16
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,167.66 |
| Max. Negotiated Rate |
$8,622.72 |
| Rate for Payer: Aetna Commercial |
$6,916.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,005.96
|
| Rate for Payer: Cash Price |
$4,491.00
|
| Rate for Payer: Cigna Commercial |
$7,455.06
|
| Rate for Payer: First Health Commercial |
$8,532.90
|
| Rate for Payer: Humana Commercial |
$7,634.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,365.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,628.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,694.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,904.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.42
|
| Rate for Payer: PHCS Commercial |
$8,622.72
|
| Rate for Payer: United Healthcare All Payer |
$7,904.16
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
OP
|
$14,460.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
76102453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,879.80 |
| Max. Negotiated Rate |
$13,881.60 |
| Rate for Payer: Aetna Commercial |
$11,134.20
|
| Rate for Payer: Anthem Medicaid |
$4,972.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,278.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$7,230.00
|
| Rate for Payer: Cash Price |
$7,230.00
|
| Rate for Payer: Cigna Commercial |
$12,001.80
|
| Rate for Payer: First Health Commercial |
$13,737.00
|
| Rate for Payer: Humana Commercial |
$12,291.00
|
| Rate for Payer: Humana KY Medicaid |
$4,972.79
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$5,023.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,857.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,671.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,072.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,879.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,482.60
|
| Rate for Payer: PHCS Commercial |
$13,881.60
|
| Rate for Payer: United Healthcare All Payer |
$12,724.80
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Professional
|
Both
|
$14,460.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
76102453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$14,460.00 |
| Rate for Payer: Anthem Medicaid |
$435.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$14,460.00
|
| Rate for Payer: Cash Price |
$7,230.00
|
| Rate for Payer: Cash Price |
$7,230.00
|
| Rate for Payer: Cigna Commercial |
$966.56
|
| Rate for Payer: Healthspan PPO |
$640.55
|
| Rate for Payer: Humana Medicaid |
$435.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$690.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.90
|
| Rate for Payer: Molina Healthcare Passport |
$435.20
|
| Rate for Payer: Multiplan PHCS |
$8,676.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10,122.00
|
| Rate for Payer: UHCCP Medicaid |
$5,061.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$439.55
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
IP
|
$14,460.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
76102453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,879.80 |
| Max. Negotiated Rate |
$13,881.60 |
| Rate for Payer: Aetna Commercial |
$11,134.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,278.80
|
| Rate for Payer: Cash Price |
$7,230.00
|
| Rate for Payer: Cigna Commercial |
$12,001.80
|
| Rate for Payer: First Health Commercial |
$13,737.00
|
| Rate for Payer: Humana Commercial |
$12,291.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,857.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,671.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,338.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,879.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,482.60
|
| Rate for Payer: PHCS Commercial |
$13,881.60
|
| Rate for Payer: United Healthcare All Payer |
$12,724.80
|
|
|
PRQ CARD REVASC CHRONIC 1VSL
|
Facility
|
OP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
48100055
|
|
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 REVASC CHRONIC 1VSL
|
Facility
|
OP
|
$19,981.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
76102464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,597.55 |
| Max. Negotiated Rate |
$19,181.88 |
| Rate for Payer: Aetna Commercial |
$15,385.46
|
| Rate for Payer: Anthem Medicaid |
$6,871.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,585.27
|
| 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 |
$9,990.56
|
| Rate for Payer: Cash Price |
$9,990.56
|
| Rate for Payer: Cigna Commercial |
$16,584.33
|
| Rate for Payer: First Health Commercial |
$18,982.06
|
| Rate for Payer: Humana Commercial |
$16,983.95
|
| Rate for Payer: Humana KY Medicaid |
$6,871.51
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,941.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,384.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,746.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,009.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$14,985.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,996.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,597.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,194.15
|
| Rate for Payer: PHCS Commercial |
$19,181.88
|
| Rate for Payer: United Healthcare All Payer |
$17,583.39
|
|
|
PRQ CARD REVASC CHRONIC 1VSL
|
Professional
|
Both
|
$19,981.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
76102464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.56 |
| Max. Negotiated Rate |
$19,981.12 |
| Rate for Payer: Anthem Medicaid |
$541.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$19,981.12
|
| Rate for Payer: Cash Price |
$9,990.56
|
| Rate for Payer: Cash Price |
$9,990.56
|
| Rate for Payer: Cigna Commercial |
$1,202.92
|
| Rate for Payer: Healthspan PPO |
$797.55
|
| Rate for Payer: Humana Medicaid |
$541.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.39
|
| Rate for Payer: Molina Healthcare Passport |
$541.56
|
| Rate for Payer: Multiplan PHCS |
$11,988.67
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13,986.78
|
| Rate for Payer: UHCCP Medicaid |
$6,993.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
|
|
PRQ CARD REVASC CHRONIC 1VSL
|
Facility
|
IP
|
$19,981.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
76102464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,597.55 |
| Max. Negotiated Rate |
$19,181.88 |
| Rate for Payer: Aetna Commercial |
$15,385.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,585.27
|
| Rate for Payer: Cash Price |
$9,990.56
|
| Rate for Payer: Cigna Commercial |
$16,584.33
|
| Rate for Payer: First Health Commercial |
$18,982.06
|
| Rate for Payer: Humana Commercial |
$16,983.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,384.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,746.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,994.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$14,985.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,996.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,597.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,194.15
|
| Rate for Payer: PHCS Commercial |
$19,181.88
|
| Rate for Payer: United Healthcare All Payer |
$17,583.39
|
|
|
PRQ CARD REVASC CHRONIC 1VSL
|
Facility
|
IP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
48100055
|
|
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 REVASC CHRONIC 1VS(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
761P2464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,202.92 |
| Rate for Payer: Anthem Medicaid |
$541.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,202.92
|
| Rate for Payer: Healthspan PPO |
$797.55
|
| Rate for Payer: Humana Medicaid |
$541.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$859.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.39
|
| Rate for Payer: Molina Healthcare Passport |
$541.56
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
|
|
PRQ CARD REVASC CHRONIC 1VS(T
|
Facility
|
IP
|
$18,881.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
761T2464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,454.55 |
| Max. Negotiated Rate |
$18,125.88 |
| Rate for Payer: Aetna Commercial |
$14,538.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,727.27
|
| Rate for Payer: Cash Price |
$9,440.56
|
| Rate for Payer: Cigna Commercial |
$15,671.33
|
| Rate for Payer: First Health Commercial |
$17,937.06
|
| Rate for Payer: Humana Commercial |
$16,048.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,482.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,934.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,664.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,615.39
|
| Rate for Payer: Ohio Health Group HMO |
$14,160.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,776.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,454.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.15
|
| Rate for Payer: PHCS Commercial |
$18,125.88
|
| Rate for Payer: United Healthcare All Payer |
$16,615.39
|
|
|
PRQ CARD REVASC CHRONIC 1VS(T
|
Facility
|
OP
|
$18,881.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
761T2464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,454.55 |
| Max. Negotiated Rate |
$18,125.88 |
| Rate for Payer: Aetna Commercial |
$14,538.46
|
| Rate for Payer: Anthem Medicaid |
$6,493.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,727.27
|
| 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 |
$9,440.56
|
| Rate for Payer: Cash Price |
$9,440.56
|
| Rate for Payer: Cigna Commercial |
$15,671.33
|
| Rate for Payer: First Health Commercial |
$17,937.06
|
| Rate for Payer: Humana Commercial |
$16,048.95
|
| Rate for Payer: Humana KY Medicaid |
$6,493.22
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,559.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,482.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,934.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,623.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,615.39
|
| Rate for Payer: Ohio Health Group HMO |
$14,160.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,776.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,454.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.15
|
| Rate for Payer: PHCS Commercial |
$18,125.88
|
| Rate for Payer: United Healthcare All Payer |
$16,615.39
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Facility
|
OP
|
$15,032.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
48100056
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,954.16 |
| Max. Negotiated Rate |
$14,430.72 |
| Rate for Payer: Aetna Commercial |
$11,574.64
|
| Rate for Payer: Anthem Medicaid |
$5,169.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,724.96
|
| Rate for Payer: Cash Price |
$7,516.00
|
| Rate for Payer: Cigna Commercial |
$12,476.56
|
| Rate for Payer: First Health Commercial |
$14,280.40
|
| Rate for Payer: Humana Commercial |
$12,777.20
|
| Rate for Payer: Humana KY Medicaid |
$5,169.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,222.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,326.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,093.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,509.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,273.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,228.16
|
| Rate for Payer: Ohio Health Group HMO |
$11,274.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,006.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,954.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,659.92
|
| Rate for Payer: PHCS Commercial |
$14,430.72
|
| Rate for Payer: United Healthcare All Payer |
$13,228.16
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Professional
|
Both
|
$14,737.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
76102465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$14,737.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$14,737.00
|
| Rate for Payer: Cash Price |
$7,368.50
|
| Rate for Payer: Cash Price |
$7,368.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$8,842.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10,315.90
|
| Rate for Payer: UHCCP Medicaid |
$5,157.95
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Facility
|
OP
|
$14,737.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
76102465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,915.81 |
| Max. Negotiated Rate |
$14,147.52 |
| Rate for Payer: Aetna Commercial |
$11,347.49
|
| Rate for Payer: Anthem Medicaid |
$5,068.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,494.86
|
| Rate for Payer: Cash Price |
$7,368.50
|
| Rate for Payer: Cigna Commercial |
$12,231.71
|
| Rate for Payer: First Health Commercial |
$14,000.15
|
| Rate for Payer: Humana Commercial |
$12,526.45
|
| Rate for Payer: Humana KY Medicaid |
$5,068.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,119.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,084.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,875.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,421.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,169.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,968.56
|
| Rate for Payer: Ohio Health Group HMO |
$11,052.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,915.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,568.47
|
| Rate for Payer: PHCS Commercial |
$14,147.52
|
| Rate for Payer: United Healthcare All Payer |
$12,968.56
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Facility
|
IP
|
$15,032.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
48100056
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,954.16 |
| Max. Negotiated Rate |
$14,430.72 |
| Rate for Payer: Aetna Commercial |
$11,574.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,724.96
|
| Rate for Payer: Cash Price |
$7,516.00
|
| Rate for Payer: Cigna Commercial |
$12,476.56
|
| Rate for Payer: First Health Commercial |
$14,280.40
|
| Rate for Payer: Humana Commercial |
$12,777.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,326.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,093.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,509.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,228.16
|
| Rate for Payer: Ohio Health Group HMO |
$11,274.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,006.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,954.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,659.92
|
| Rate for Payer: PHCS Commercial |
$14,430.72
|
| Rate for Payer: United Healthcare All Payer |
$13,228.16
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Facility
|
IP
|
$14,737.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
76102465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,915.81 |
| Max. Negotiated Rate |
$14,147.52 |
| Rate for Payer: Aetna Commercial |
$11,347.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,494.86
|
| Rate for Payer: Cash Price |
$7,368.50
|
| Rate for Payer: Cigna Commercial |
$12,231.71
|
| Rate for Payer: First Health Commercial |
$14,000.15
|
| Rate for Payer: Humana Commercial |
$12,526.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,084.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,875.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,421.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,968.56
|
| Rate for Payer: Ohio Health Group HMO |
$11,052.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,915.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,568.47
|
| Rate for Payer: PHCS Commercial |
$14,147.52
|
| Rate for Payer: United Healthcare All Payer |
$12,968.56
|
|
