|
PRQ CARD REVASC CHRONIC ADD(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
761P2465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,100.00 |
| 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: Healthspan PPO |
$0.60
|
| 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
|
|
|
PRQ CARD REVASC CHRONIC ADD(T
|
Facility
|
OP
|
$13,637.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
761T2465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,772.81 |
| Max. Negotiated Rate |
$13,091.52 |
| Rate for Payer: Aetna Commercial |
$10,500.49
|
| Rate for Payer: Anthem Medicaid |
$4,689.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,636.86
|
| Rate for Payer: Cash Price |
$6,818.50
|
| Rate for Payer: Cigna Commercial |
$11,318.71
|
| Rate for Payer: First Health Commercial |
$12,955.15
|
| Rate for Payer: Humana Commercial |
$11,591.45
|
| Rate for Payer: Humana KY Medicaid |
$4,689.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,737.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,182.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,064.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,091.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,783.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,727.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,227.47
|
| Rate for Payer: PHCS Commercial |
$13,091.52
|
| Rate for Payer: United Healthcare All Payer |
$12,000.56
|
|
|
PRQ CARD REVASC CHRONIC ADD(T
|
Facility
|
IP
|
$13,637.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
761T2465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,772.81 |
| Max. Negotiated Rate |
$13,091.52 |
| Rate for Payer: Aetna Commercial |
$10,500.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,636.86
|
| Rate for Payer: Cash Price |
$6,818.50
|
| Rate for Payer: Cigna Commercial |
$11,318.71
|
| Rate for Payer: First Health Commercial |
$12,955.15
|
| Rate for Payer: Humana Commercial |
$11,591.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,182.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,064.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,091.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$10,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,727.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,227.47
|
| Rate for Payer: PHCS Commercial |
$13,091.52
|
| Rate for Payer: United Healthcare All Payer |
$12,000.56
|
|
|
PRQ CARD REVASC MI 1 VSL
|
Facility
|
IP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
48100054
|
|
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 MI 1 VSL
|
Facility
|
OP
|
$19,551.94
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
76102463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,541.75 |
| Max. Negotiated Rate |
$18,769.86 |
| Rate for Payer: Aetna Commercial |
$15,054.99
|
| Rate for Payer: Anthem Medicaid |
$6,723.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,250.51
|
| Rate for Payer: Cash Price |
$9,775.97
|
| Rate for Payer: Cigna Commercial |
$16,228.11
|
| Rate for Payer: First Health Commercial |
$18,574.34
|
| Rate for Payer: Humana Commercial |
$16,619.15
|
| Rate for Payer: Humana KY Medicaid |
$6,723.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,792.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,032.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,429.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,865.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,858.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,205.71
|
| Rate for Payer: Ohio Health Group HMO |
$14,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,910.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,541.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.10
|
| Rate for Payer: PHCS Commercial |
$18,769.86
|
| Rate for Payer: United Healthcare All Payer |
$17,205.71
|
|
|
PRQ CARD REVASC MI 1 VSL
|
Facility
|
IP
|
$19,551.94
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
76102463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,541.75 |
| Max. Negotiated Rate |
$18,769.86 |
| Rate for Payer: Aetna Commercial |
$15,054.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,250.51
|
| Rate for Payer: Cash Price |
$9,775.97
|
| Rate for Payer: Cigna Commercial |
$16,228.11
|
| Rate for Payer: First Health Commercial |
$18,574.34
|
| Rate for Payer: Humana Commercial |
$16,619.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,032.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,429.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,865.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,205.71
|
| Rate for Payer: Ohio Health Group HMO |
$14,663.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,910.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,541.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,061.10
|
| Rate for Payer: PHCS Commercial |
$18,769.86
|
| Rate for Payer: United Healthcare All Payer |
$17,205.71
|
|
|
PRQ CARD REVASC MI 1 VSL
|
Facility
|
OP
|
$16,540.00
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
48100054
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,150.20 |
| Max. Negotiated Rate |
$15,878.40 |
| Rate for Payer: Aetna Commercial |
$12,735.80
|
| Rate for Payer: Anthem Medicaid |
$5,688.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.20
|
| Rate for Payer: Cash Price |
$8,270.00
|
| Rate for Payer: Cigna Commercial |
$13,728.20
|
| Rate for Payer: First Health Commercial |
$15,713.00
|
| Rate for Payer: Humana Commercial |
$14,059.00
|
| Rate for Payer: Humana KY Medicaid |
$5,688.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,802.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.40
|
| Rate for Payer: PHCS Commercial |
$15,878.40
|
| Rate for Payer: United Healthcare All Payer |
$14,555.20
|
|
|
PRQ CARD REVASC MI 1 VSL
|
Professional
|
Both
|
$19,551.94
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
76102463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.56 |
| Max. Negotiated Rate |
$19,551.94 |
| Rate for Payer: Anthem Medicaid |
$541.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$19,551.94
|
| Rate for Payer: Cash Price |
$9,775.97
|
| Rate for Payer: Cash Price |
$9,775.97
|
| 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 |
$11,731.16
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13,686.36
|
| Rate for Payer: UHCCP Medicaid |
$6,843.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
|
|
PRQ CARD REVASC MI 1 VSL(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
761P2463
|
|
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 MI 1 VSL(T
|
Facility
|
OP
|
$18,451.94
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
761T2463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,398.75 |
| Max. Negotiated Rate |
$17,713.86 |
| Rate for Payer: Aetna Commercial |
$14,207.99
|
| Rate for Payer: Anthem Medicaid |
$6,345.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,392.51
|
| Rate for Payer: Cash Price |
$9,225.97
|
| Rate for Payer: Cigna Commercial |
$15,315.11
|
| Rate for Payer: First Health Commercial |
$17,529.34
|
| Rate for Payer: Humana Commercial |
$15,684.15
|
| Rate for Payer: Humana KY Medicaid |
$6,345.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,410.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,130.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,617.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,535.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,472.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,237.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,838.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,398.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.10
|
| Rate for Payer: PHCS Commercial |
$17,713.86
|
| Rate for Payer: United Healthcare All Payer |
$16,237.71
|
|
|
PRQ CARD REVASC MI 1 VSL(T
|
Facility
|
IP
|
$18,451.94
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
761T2463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,398.75 |
| Max. Negotiated Rate |
$17,713.86 |
| Rate for Payer: Aetna Commercial |
$14,207.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,392.51
|
| Rate for Payer: Cash Price |
$9,225.97
|
| Rate for Payer: Cigna Commercial |
$15,315.11
|
| Rate for Payer: First Health Commercial |
$17,529.34
|
| Rate for Payer: Humana Commercial |
$15,684.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,130.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,617.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,535.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,237.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,838.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,690.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,398.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,720.10
|
| Rate for Payer: PHCS Commercial |
$17,713.86
|
| Rate for Payer: United Healthcare All Payer |
$16,237.71
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Professional
|
Both
|
$24,081.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
76102459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.51 |
| Max. Negotiated Rate |
$24,081.00 |
| Rate for Payer: Anthem Medicaid |
$540.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$24,081.00
|
| Rate for Payer: Cash Price |
$12,040.50
|
| Rate for Payer: Cash Price |
$12,040.50
|
| Rate for Payer: Cigna Commercial |
$1,200.51
|
| Rate for Payer: Healthspan PPO |
$795.91
|
| Rate for Payer: Humana Medicaid |
$540.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$551.32
|
| Rate for Payer: Molina Healthcare Passport |
$540.51
|
| Rate for Payer: Multiplan PHCS |
$14,448.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16,856.70
|
| Rate for Payer: UHCCP Medicaid |
$8,428.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$545.92
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
IP
|
$15,032.00
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
48100051
|
|
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 STENT/ATH/ANGIO
|
Facility
|
IP
|
$24,829.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,227.77 |
| Max. Negotiated Rate |
$23,835.84 |
| Rate for Payer: Aetna Commercial |
$19,118.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,366.62
|
| Rate for Payer: Cash Price |
$12,414.50
|
| Rate for Payer: Cigna Commercial |
$20,608.07
|
| Rate for Payer: First Health Commercial |
$23,587.55
|
| Rate for Payer: Humana Commercial |
$21,104.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,359.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,323.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,448.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,849.52
|
| Rate for Payer: Ohio Health Group HMO |
$18,621.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,965.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,227.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,696.99
|
| Rate for Payer: PHCS Commercial |
$23,835.84
|
| Rate for Payer: United Healthcare All Payer |
$21,849.52
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
OP
|
$13,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
76102460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,696.82 |
| Max. Negotiated Rate |
$12,530.40 |
| Rate for Payer: Aetna Commercial |
$10,050.42
|
| Rate for Payer: Anthem Medicaid |
$4,488.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,180.95
|
| Rate for Payer: Cash Price |
$6,526.25
|
| Rate for Payer: Cigna Commercial |
$10,833.58
|
| Rate for Payer: First Health Commercial |
$12,399.88
|
| Rate for Payer: Humana Commercial |
$11,094.62
|
| Rate for Payer: Humana KY Medicaid |
$4,488.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,534.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,703.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,632.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,915.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,486.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,789.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,610.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,046.28
|
| Rate for Payer: PHCS Commercial |
$12,530.40
|
| Rate for Payer: United Healthcare All Payer |
$11,486.20
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Professional
|
Both
|
$13,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
76102460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$13,052.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$13,052.50
|
| Rate for Payer: Cash Price |
$6,526.25
|
| Rate for Payer: Cash Price |
$6,526.25
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$7,831.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9,136.75
|
| Rate for Payer: UHCCP Medicaid |
$4,568.38
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
OP
|
$15,032.00
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
48100051
|
|
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 STENT/ATH/ANGIO
|
Facility
|
OP
|
$24,829.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,227.77 |
| Max. Negotiated Rate |
$23,835.84 |
| Rate for Payer: Aetna Commercial |
$19,118.33
|
| Rate for Payer: Anthem Medicaid |
$8,538.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,366.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$12,414.50
|
| Rate for Payer: Cash Price |
$12,414.50
|
| Rate for Payer: Cigna Commercial |
$20,608.07
|
| Rate for Payer: First Health Commercial |
$23,587.55
|
| Rate for Payer: Humana Commercial |
$21,104.65
|
| Rate for Payer: Humana KY Medicaid |
$8,538.69
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$8,625.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,359.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,323.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,710.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,849.52
|
| Rate for Payer: Ohio Health Group HMO |
$18,621.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,965.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,227.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,696.99
|
| Rate for Payer: PHCS Commercial |
$23,835.84
|
| Rate for Payer: United Healthcare All Payer |
$21,849.52
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
IP
|
$13,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
76102460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,696.82 |
| Max. Negotiated Rate |
$12,530.40 |
| Rate for Payer: Aetna Commercial |
$10,050.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,180.95
|
| Rate for Payer: Cash Price |
$6,526.25
|
| Rate for Payer: Cigna Commercial |
$10,833.58
|
| Rate for Payer: First Health Commercial |
$12,399.88
|
| Rate for Payer: Humana Commercial |
$11,094.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,703.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,632.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,915.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,486.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,789.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,610.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,046.28
|
| Rate for Payer: PHCS Commercial |
$12,530.40
|
| Rate for Payer: United Healthcare All Payer |
$11,486.20
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
IP
|
$24,081.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
76102459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,130.53 |
| Max. Negotiated Rate |
$23,117.76 |
| Rate for Payer: Aetna Commercial |
$18,542.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,783.18
|
| Rate for Payer: Cash Price |
$12,040.50
|
| Rate for Payer: Cigna Commercial |
$19,987.23
|
| Rate for Payer: First Health Commercial |
$22,876.95
|
| Rate for Payer: Humana Commercial |
$20,468.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,746.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,771.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,224.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,191.28
|
| Rate for Payer: Ohio Health Group HMO |
$18,060.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,816.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,465.11
|
| Rate for Payer: PHCS Commercial |
$23,117.76
|
| Rate for Payer: United Healthcare All Payer |
$21,191.28
|
|
|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
OP
|
$24,081.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
76102459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,130.53 |
| Max. Negotiated Rate |
$23,117.76 |
| Rate for Payer: Aetna Commercial |
$18,542.37
|
| Rate for Payer: Anthem Medicaid |
$8,281.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,783.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$12,040.50
|
| Rate for Payer: Cash Price |
$12,040.50
|
| Rate for Payer: Cigna Commercial |
$19,987.23
|
| Rate for Payer: First Health Commercial |
$22,876.95
|
| Rate for Payer: Humana Commercial |
$20,468.85
|
| Rate for Payer: Humana KY Medicaid |
$8,281.46
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,746.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,771.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,447.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,191.28
|
| Rate for Payer: Ohio Health Group HMO |
$18,060.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,816.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,465.11
|
| Rate for Payer: PHCS Commercial |
$23,117.76
|
| Rate for Payer: United Healthcare All Payer |
$21,191.28
|
|
|
PRQ CARD STENT/ATH/ANGIO(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
761P2459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Anthem Medicaid |
$540.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,200.51
|
| Rate for Payer: Healthspan PPO |
$795.91
|
| Rate for Payer: Humana Medicaid |
$540.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$551.32
|
| Rate for Payer: Molina Healthcare Passport |
$540.51
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$545.92
|
|
|
PRQ CARD STENT/ATH/ANGIO(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
761P2460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,000.00 |
| 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: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
PRQ CARD STENT/ATH/ANGIO(T
|
Facility
|
OP
|
$22,831.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
761T2459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,968.03 |
| Max. Negotiated Rate |
$21,917.76 |
| Rate for Payer: Aetna Commercial |
$17,579.87
|
| Rate for Payer: Anthem Medicaid |
$7,851.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,808.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$11,415.50
|
| Rate for Payer: Cash Price |
$11,415.50
|
| Rate for Payer: Cigna Commercial |
$18,949.73
|
| Rate for Payer: First Health Commercial |
$21,689.45
|
| Rate for Payer: Humana Commercial |
$19,406.35
|
| Rate for Payer: Humana KY Medicaid |
$7,851.58
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$7,931.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,721.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,849.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,009.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,091.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,123.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,566.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,968.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,077.61
|
| Rate for Payer: PHCS Commercial |
$21,917.76
|
| Rate for Payer: United Healthcare All Payer |
$20,091.28
|
|
|
PRQ CARD STENT/ATH/ANGIO(T
|
Facility
|
IP
|
$12,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
761T2460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,566.82 |
| Max. Negotiated Rate |
$11,570.40 |
| Rate for Payer: Aetna Commercial |
$9,280.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,400.95
|
| Rate for Payer: Cash Price |
$6,026.25
|
| Rate for Payer: Cigna Commercial |
$10,003.58
|
| Rate for Payer: First Health Commercial |
$11,449.88
|
| Rate for Payer: Humana Commercial |
$10,244.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,883.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,894.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,615.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,606.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,039.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,410.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,736.28
|
| Rate for Payer: PHCS Commercial |
$11,570.40
|
| Rate for Payer: United Healthcare All Payer |
$10,606.20
|
|
