|
PRQ CARD ANGIO/ATHRECT 1 ART
|
Facility
|
IP
|
$22,301.13
|
|
|
Service Code
|
HCPCS 92924
|
| Hospital Charge Code |
76102455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,690.34 |
| Max. Negotiated Rate |
$21,409.08 |
| Rate for Payer: Aetna Commercial |
$17,171.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,394.88
|
| Rate for Payer: Cash Price |
$11,150.57
|
| Rate for Payer: Cigna Commercial |
$18,509.94
|
| Rate for Payer: First Health Commercial |
$21,186.07
|
| Rate for Payer: Humana Commercial |
$18,955.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,286.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,458.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,690.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,624.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,725.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,840.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,401.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,387.78
|
| Rate for Payer: PHCS Commercial |
$21,409.08
|
| Rate for Payer: United Healthcare All Payer |
$19,624.99
|
|
|
PRQ CARD ANGIO/ATHRECT 1 ART
|
Professional
|
Both
|
$22,301.13
|
|
|
Service Code
|
HCPCS 92924
|
| Hospital Charge Code |
76102455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.11 |
| Max. Negotiated Rate |
$13,380.68 |
| Rate for Payer: Ambetter Exchange |
$587.89
|
| Rate for Payer: Anthem Medicaid |
$517.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$587.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$587.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$705.47
|
| Rate for Payer: Cash Price |
$11,150.57
|
| Rate for Payer: Cash Price |
$11,150.57
|
| Rate for Payer: Cigna Commercial |
$1,149.05
|
| Rate for Payer: Healthspan PPO |
$761.26
|
| Rate for Payer: Humana Medicaid |
$517.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$821.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$587.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$587.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$527.45
|
| Rate for Payer: Molina Healthcare Passport |
$517.11
|
| Rate for Payer: Multiplan PHCS |
$13,380.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$764.26
|
| Rate for Payer: UHCCP Medicaid |
$7,805.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$522.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$587.89
|
|
|
PRQ CARD ANGIO/ATHRECT 1 ART
|
Facility
|
OP
|
$22,301.13
|
|
|
Service Code
|
HCPCS 92924
|
| Hospital Charge Code |
76102455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,669.36 |
| Max. Negotiated Rate |
$21,409.08 |
| Rate for Payer: Aetna Commercial |
$17,171.87
|
| Rate for Payer: Anthem Medicaid |
$7,669.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,394.88
|
| 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 |
$11,150.57
|
| Rate for Payer: Cash Price |
$11,150.57
|
| Rate for Payer: Cigna Commercial |
$18,509.94
|
| Rate for Payer: First Health Commercial |
$21,186.07
|
| Rate for Payer: Humana Commercial |
$18,955.96
|
| Rate for Payer: Humana KY Medicaid |
$7,669.36
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,747.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,286.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,458.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,823.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,624.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,725.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,840.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,401.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,387.78
|
| Rate for Payer: PHCS Commercial |
$21,409.08
|
| Rate for Payer: United Healthcare All Payer |
$19,624.99
|
|
|
PRQ CARD ANGIO ATHRECT ADDL
|
Facility
|
IP
|
$14,722.00
|
|
|
Service Code
|
HCPCS 92925
|
| Hospital Charge Code |
76102456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,416.60 |
| Max. Negotiated Rate |
$14,133.12 |
| Rate for Payer: Aetna Commercial |
$11,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,483.16
|
| Rate for Payer: Cash Price |
$7,361.00
|
| Rate for Payer: Cigna Commercial |
$12,219.26
|
| Rate for Payer: First Health Commercial |
$13,985.90
|
| Rate for Payer: Humana Commercial |
$12,513.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,072.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,864.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,416.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,955.36
|
| Rate for Payer: Ohio Health Group HMO |
$11,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,777.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,808.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,158.18
|
| Rate for Payer: PHCS Commercial |
$14,133.12
|
| Rate for Payer: United Healthcare All Payer |
$12,955.36
|
|
|
PRQ CARD ANGIO ATHRECT ADDL
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 92925
|
| Hospital Charge Code |
76102456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,050.00 |
| 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 CARD ANGIO ATHRECT ADDL
|
Facility
|
OP
|
$14,722.00
|
|
|
Service Code
|
HCPCS 92925
|
| Hospital Charge Code |
76102456
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,416.60 |
| Max. Negotiated Rate |
$14,133.12 |
| Rate for Payer: Aetna Commercial |
$11,335.94
|
| Rate for Payer: Anthem Medicaid |
$5,062.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,483.16
|
| Rate for Payer: Cash Price |
$7,361.00
|
| Rate for Payer: Cigna Commercial |
$12,219.26
|
| Rate for Payer: First Health Commercial |
$13,985.90
|
| Rate for Payer: Humana Commercial |
$12,513.70
|
| Rate for Payer: Humana KY Medicaid |
$5,062.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,114.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,072.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,864.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,416.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,164.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,955.36
|
| Rate for Payer: Ohio Health Group HMO |
$11,041.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,777.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,808.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,158.18
|
| Rate for Payer: PHCS Commercial |
$14,133.12
|
| Rate for Payer: United Healthcare All Payer |
$12,955.36
|
|
|
PRQ CARDIAC ANGIO ADDL ART
|
Professional
|
Both
|
$11,507.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
76102454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$8,054.90 |
| Rate for Payer: Cash Price |
$5,753.50
|
| Rate for Payer: Cash Price |
$5,753.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$6,904.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,054.90
|
| Rate for Payer: UHCCP Medicaid |
$4,027.45
|
|
|
PRQ CARDIAC ANGIO ADDL ART
|
Facility
|
IP
|
$9,566.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
48100045
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,869.80 |
| Max. Negotiated Rate |
$9,183.36 |
| Rate for Payer: Aetna Commercial |
$7,365.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,461.48
|
| Rate for Payer: Cash Price |
$4,783.00
|
| Rate for Payer: Cigna Commercial |
$7,939.78
|
| Rate for Payer: First Health Commercial |
$9,087.70
|
| Rate for Payer: Humana Commercial |
$8,131.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,844.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,059.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,418.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,174.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,322.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,600.54
|
| Rate for Payer: PHCS Commercial |
$9,183.36
|
| Rate for Payer: United Healthcare All Payer |
$8,418.08
|
|
|
PRQ CARDIAC ANGIO ADDL ART
|
Facility
|
OP
|
$11,507.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
76102454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,452.10 |
| Max. Negotiated Rate |
$11,046.72 |
| Rate for Payer: Aetna Commercial |
$8,860.39
|
| Rate for Payer: Anthem Medicaid |
$3,957.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,975.46
|
| Rate for Payer: Cash Price |
$5,753.50
|
| Rate for Payer: Cigna Commercial |
$9,550.81
|
| Rate for Payer: First Health Commercial |
$10,931.65
|
| Rate for Payer: Humana Commercial |
$9,780.95
|
| Rate for Payer: Humana KY Medicaid |
$3,957.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,997.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,435.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,492.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,036.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,126.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,630.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,011.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,939.83
|
| Rate for Payer: PHCS Commercial |
$11,046.72
|
| Rate for Payer: United Healthcare All Payer |
$10,126.16
|
|
|
PRQ CARDIAC ANGIO ADDL ART
|
Facility
|
IP
|
$11,507.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
76102454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,452.10 |
| Max. Negotiated Rate |
$11,046.72 |
| Rate for Payer: Aetna Commercial |
$8,860.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,975.46
|
| Rate for Payer: Cash Price |
$5,753.50
|
| Rate for Payer: Cigna Commercial |
$9,550.81
|
| Rate for Payer: First Health Commercial |
$10,931.65
|
| Rate for Payer: Humana Commercial |
$9,780.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,435.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,492.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,126.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,630.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,011.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,939.83
|
| Rate for Payer: PHCS Commercial |
$11,046.72
|
| Rate for Payer: United Healthcare All Payer |
$10,126.16
|
|
|
PRQ CARDIAC ANGIO ADDL ART
|
Facility
|
OP
|
$9,566.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
48100045
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,869.80 |
| Max. Negotiated Rate |
$9,183.36 |
| Rate for Payer: Aetna Commercial |
$7,365.82
|
| Rate for Payer: Anthem Medicaid |
$3,289.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,461.48
|
| Rate for Payer: Cash Price |
$4,783.00
|
| Rate for Payer: Cigna Commercial |
$7,939.78
|
| Rate for Payer: First Health Commercial |
$9,087.70
|
| Rate for Payer: Humana Commercial |
$8,131.10
|
| Rate for Payer: Humana KY Medicaid |
$3,289.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,323.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,844.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,059.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,355.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,418.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,174.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,322.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,600.54
|
| Rate for Payer: PHCS Commercial |
$9,183.36
|
| Rate for Payer: United Healthcare All Payer |
$8,418.08
|
|
|
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 |
$1,050.00 |
| 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
|
IP
|
$10,007.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
761T2454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,002.10 |
| 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 |
$8,005.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,706.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,904.83
|
| 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
|
OP
|
$10,007.00
|
|
|
Service Code
|
HCPCS 92921
|
| Hospital Charge Code |
761T2454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,002.10 |
| 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 |
$8,005.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,706.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,904.83
|
| 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 |
$966.56 |
| Rate for Payer: Ambetter Exchange |
$493.57
|
| Rate for Payer: Anthem Medicaid |
$435.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$493.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$493.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$592.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$493.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$493.57
|
| 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 |
$641.64
|
| Rate for Payer: UHCCP Medicaid |
$367.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$439.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$493.57
|
|
|
PRQ CARDIAC ANGIOPLAST 1 AR(T
|
Facility
|
IP
|
$13,879.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
761T2453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,163.70 |
| Max. Negotiated Rate |
$13,323.84 |
| Rate for Payer: Aetna Commercial |
$10,686.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,825.62
|
| Rate for Payer: Cash Price |
$6,939.50
|
| Rate for Payer: Cigna Commercial |
$11,519.57
|
| Rate for Payer: First Health Commercial |
$13,185.05
|
| Rate for Payer: Humana Commercial |
$11,797.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,380.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,242.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,213.52
|
| Rate for Payer: Ohio Health Group HMO |
$10,409.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,074.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,576.51
|
| Rate for Payer: PHCS Commercial |
$13,323.84
|
| Rate for Payer: United Healthcare All Payer |
$12,213.52
|
|
|
PRQ CARDIAC ANGIOPLAST 1 AR(T
|
Facility
|
OP
|
$13,879.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
761T2453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,772.99 |
| Max. Negotiated Rate |
$13,323.84 |
| Rate for Payer: Aetna Commercial |
$10,686.83
|
| Rate for Payer: Anthem Medicaid |
$4,772.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,825.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$6,939.50
|
| Rate for Payer: Cash Price |
$6,939.50
|
| Rate for Payer: Cigna Commercial |
$11,519.57
|
| Rate for Payer: First Health Commercial |
$13,185.05
|
| Rate for Payer: Humana Commercial |
$11,797.15
|
| Rate for Payer: Humana KY Medicaid |
$4,772.99
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,821.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,380.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,242.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,213.52
|
| Rate for Payer: Ohio Health Group HMO |
$10,409.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,074.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,576.51
|
| Rate for Payer: PHCS Commercial |
$13,323.84
|
| Rate for Payer: United Healthcare All Payer |
$12,213.52
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
OP
|
$14,929.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
76102453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,134.08 |
| Max. Negotiated Rate |
$14,331.84 |
| Rate for Payer: Aetna Commercial |
$11,495.33
|
| Rate for Payer: Anthem Medicaid |
$5,134.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,644.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$7,464.50
|
| Rate for Payer: Cash Price |
$7,464.50
|
| Rate for Payer: Cigna Commercial |
$12,391.07
|
| Rate for Payer: First Health Commercial |
$14,182.55
|
| Rate for Payer: Humana Commercial |
$12,689.65
|
| Rate for Payer: Humana KY Medicaid |
$5,134.08
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$5,186.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,241.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,017.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,237.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,196.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,943.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,988.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,301.01
|
| Rate for Payer: PHCS Commercial |
$14,331.84
|
| Rate for Payer: United Healthcare All Payer |
$13,137.52
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
IP
|
$14,929.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
76102453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,478.70 |
| Max. Negotiated Rate |
$14,331.84 |
| Rate for Payer: Aetna Commercial |
$11,495.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,644.62
|
| Rate for Payer: Cash Price |
$7,464.50
|
| Rate for Payer: Cigna Commercial |
$12,391.07
|
| Rate for Payer: First Health Commercial |
$14,182.55
|
| Rate for Payer: Humana Commercial |
$12,689.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,241.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,017.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,478.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,196.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,943.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,988.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,301.01
|
| Rate for Payer: PHCS Commercial |
$14,331.84
|
| Rate for Payer: United Healthcare All Payer |
$13,137.52
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
IP
|
$9,566.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,869.80 |
| Max. Negotiated Rate |
$9,183.36 |
| Rate for Payer: Aetna Commercial |
$7,365.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,461.48
|
| Rate for Payer: Cash Price |
$4,783.00
|
| Rate for Payer: Cigna Commercial |
$7,939.78
|
| Rate for Payer: First Health Commercial |
$9,087.70
|
| Rate for Payer: Humana Commercial |
$8,131.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,844.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,059.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,418.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,174.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,322.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,600.54
|
| Rate for Payer: PHCS Commercial |
$9,183.36
|
| Rate for Payer: United Healthcare All Payer |
$8,418.08
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Professional
|
Both
|
$14,929.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
76102453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$8,957.40 |
| Rate for Payer: Ambetter Exchange |
$493.57
|
| Rate for Payer: Anthem Medicaid |
$435.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$493.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$493.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$592.28
|
| Rate for Payer: Cash Price |
$7,464.50
|
| Rate for Payer: Cash Price |
$7,464.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$493.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$493.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.90
|
| Rate for Payer: Molina Healthcare Passport |
$435.20
|
| Rate for Payer: Multiplan PHCS |
$8,957.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$641.64
|
| Rate for Payer: UHCCP Medicaid |
$5,225.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$439.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$493.57
|
|
|
PRQ CARDIAC ANGIOPLAST 1 ART
|
Facility
|
OP
|
$9,566.00
|
|
|
Service Code
|
HCPCS 92920
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,289.75 |
| Max. Negotiated Rate |
$9,183.36 |
| Rate for Payer: Aetna Commercial |
$7,365.82
|
| Rate for Payer: Anthem Medicaid |
$3,289.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,461.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$4,783.00
|
| Rate for Payer: Cash Price |
$4,783.00
|
| Rate for Payer: Cigna Commercial |
$7,939.78
|
| Rate for Payer: First Health Commercial |
$9,087.70
|
| Rate for Payer: Humana Commercial |
$8,131.10
|
| Rate for Payer: Humana KY Medicaid |
$3,289.75
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,323.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,844.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,059.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,355.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,418.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,174.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,322.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,600.54
|
| Rate for Payer: PHCS Commercial |
$9,183.36
|
| Rate for Payer: United Healthcare All Payer |
$8,418.08
|
|
|
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 |
$11,988.67 |
| Rate for Payer: Ambetter Exchange |
$616.27
|
| Rate for Payer: Anthem Medicaid |
$541.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$616.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.27
|
| 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 |
$801.15
|
| Rate for Payer: UHCCP Medicaid |
$6,993.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.27
|
|
|
PRQ CARD REVASC CHRONIC 1VSL
|
Facility
|
OP
|
$17,020.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
48100055
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,853.18 |
| Max. Negotiated Rate |
$16,339.20 |
| Rate for Payer: Aetna Commercial |
$13,105.40
|
| Rate for Payer: Anthem Medicaid |
$5,853.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,275.60
|
| 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 |
$8,510.00
|
| Rate for Payer: Cash Price |
$8,510.00
|
| Rate for Payer: Cigna Commercial |
$14,126.60
|
| Rate for Payer: First Health Commercial |
$16,169.00
|
| Rate for Payer: Humana Commercial |
$14,467.00
|
| Rate for Payer: Humana KY Medicaid |
$5,853.18
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,912.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,956.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,560.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,970.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,977.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,765.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,807.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,743.80
|
| Rate for Payer: PHCS Commercial |
$16,339.20
|
| Rate for Payer: United Healthcare All Payer |
$14,977.60
|
|
|
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 |
$5,994.34 |
| 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 |
$15,984.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,383.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,786.97
|
| Rate for Payer: PHCS Commercial |
$19,181.88
|
| Rate for Payer: United Healthcare All Payer |
$17,583.39
|
|
