|
PRQ CARD REVASC CHRONIC 1VSL
|
Facility
|
IP
|
$17,020.00
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
48100055
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,106.00 |
| Max. Negotiated Rate |
$16,339.20 |
| Rate for Payer: Aetna Commercial |
$13,105.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,275.60
|
| 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: 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 |
$5,106.00
|
| 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
|
OP
|
$19,981.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
76102464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,871.51 |
| 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 |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,585.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$9,990.56
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$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
|
|
|
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: 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 |
$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: 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 |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$801.15
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.27
|
|
|
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 |
$6,493.22 |
| 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 |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,727.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$9,440.56
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$15,104.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,426.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,027.97
|
| 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
|
IP
|
$18,881.12
|
|
|
Service Code
|
HCPCS 92943
|
| Hospital Charge Code |
761T2464
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,664.34 |
| 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 |
$15,104.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,426.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,027.97
|
| Rate for Payer: PHCS Commercial |
$18,125.88
|
| Rate for Payer: United Healthcare All Payer |
$16,615.39
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Facility
|
IP
|
$15,558.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
48100056
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,667.40 |
| Max. Negotiated Rate |
$14,935.68 |
| Rate for Payer: Aetna Commercial |
$11,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,135.24
|
| Rate for Payer: Cash Price |
$7,779.00
|
| Rate for Payer: Cigna Commercial |
$12,913.14
|
| Rate for Payer: First Health Commercial |
$14,780.10
|
| Rate for Payer: Humana Commercial |
$13,224.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,757.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,667.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$11,668.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,535.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,735.02
|
| Rate for Payer: PHCS Commercial |
$14,935.68
|
| Rate for Payer: United Healthcare All Payer |
$13,691.04
|
|
|
PRQ CARD REVASC CHRONIC ADDL
|
Facility
|
OP
|
$15,558.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
48100056
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,667.40 |
| Max. Negotiated Rate |
$14,935.68 |
| Rate for Payer: Aetna Commercial |
$11,979.66
|
| Rate for Payer: Anthem Medicaid |
$5,350.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,135.24
|
| Rate for Payer: Cash Price |
$7,779.00
|
| Rate for Payer: Cigna Commercial |
$12,913.14
|
| Rate for Payer: First Health Commercial |
$14,780.10
|
| Rate for Payer: Humana Commercial |
$13,224.30
|
| Rate for Payer: Humana KY Medicaid |
$5,350.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,404.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,757.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,667.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$11,668.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,535.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,735.02
|
| Rate for Payer: PHCS Commercial |
$14,935.68
|
| Rate for Payer: United Healthcare All Payer |
$13,691.04
|
|
|
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 |
$4,421.10 |
| 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 |
$11,789.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,821.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,168.53
|
| Rate for Payer: PHCS Commercial |
$14,147.52
|
| Rate for Payer: United Healthcare All Payer |
$12,968.56
|
|
|
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 |
$4,421.10 |
| 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 |
$11,789.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,821.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,168.53
|
| Rate for Payer: PHCS Commercial |
$14,147.52
|
| Rate for Payer: United Healthcare All Payer |
$12,968.56
|
|
|
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 |
$10,315.90 |
| 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 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 |
$770.00 |
| 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
|
IP
|
$13,637.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
761T2465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,091.10 |
| 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 |
$10,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,864.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,409.53
|
| 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
|
OP
|
$13,637.00
|
|
|
Service Code
|
HCPCS 92944
|
| Hospital Charge Code |
761T2465
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,091.10 |
| 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 |
$10,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,864.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,409.53
|
| 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
|
OP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
48100054
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,284.50 |
| Max. Negotiated Rate |
$16,910.40 |
| Rate for Payer: Aetna Commercial |
$13,563.55
|
| Rate for Payer: Anthem Medicaid |
$6,057.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,739.70
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cigna Commercial |
$14,620.45
|
| Rate for Payer: First Health Commercial |
$16,734.25
|
| Rate for Payer: Humana Commercial |
$14,972.75
|
| Rate for Payer: Humana KY Medicaid |
$6,057.80
|
| Rate for Payer: Kentucky WC Medicaid |
$6,119.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,999.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,284.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,179.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,501.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,211.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,325.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,154.35
|
| Rate for Payer: PHCS Commercial |
$16,910.40
|
| Rate for Payer: United Healthcare All Payer |
$15,501.20
|
|
|
PRQ CARD REVASC MI 1 VSL
|
Facility
|
IP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
48100054
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,284.50 |
| Max. Negotiated Rate |
$16,910.40 |
| Rate for Payer: Aetna Commercial |
$13,563.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,739.70
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cigna Commercial |
$14,620.45
|
| Rate for Payer: First Health Commercial |
$16,734.25
|
| Rate for Payer: Humana Commercial |
$14,972.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,999.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,284.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,501.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,211.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,325.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,154.35
|
| Rate for Payer: PHCS Commercial |
$16,910.40
|
| Rate for Payer: United Healthcare All Payer |
$15,501.20
|
|
|
PRQ 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 |
$5,865.58 |
| 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 |
$14,663.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,641.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,010.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,490.84
|
| 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 |
$5,865.58 |
| 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 |
$14,663.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,641.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,010.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,490.84
|
| Rate for Payer: PHCS Commercial |
$18,769.86
|
| Rate for Payer: United Healthcare All Payer |
$17,205.71
|
|
|
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 |
$11,731.16 |
| Rate for Payer: Ambetter Exchange |
$616.23
|
| Rate for Payer: Anthem Medicaid |
$541.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.23
|
| 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 |
$801.10
|
| Rate for Payer: UHCCP Medicaid |
$6,843.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.23
|
|
|
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: Ambetter Exchange |
$616.23
|
| Rate for Payer: Anthem Medicaid |
$541.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.23
|
| 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 |
$801.10
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.23
|
|
|
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 |
$5,535.58 |
| 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 |
$13,838.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,761.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,053.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,731.84
|
| 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
|
OP
|
$18,451.94
|
|
|
Service Code
|
HCPCS 92941
|
| Hospital Charge Code |
761T2463
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,535.58 |
| 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 |
$13,838.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,761.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,053.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,731.84
|
| Rate for Payer: PHCS Commercial |
$17,713.86
|
| Rate for Payer: United Healthcare All Payer |
$16,237.71
|
|
|
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 |
$3,915.75 |
| 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 |
$9,632.75
|
| 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 |
$10,442.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,355.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,006.23
|
| 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 |
$7,224.30 |
| 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 |
$19,264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,950.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,615.89
|
| 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
|
$13,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
76102460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,915.75 |
| 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 |
$9,632.75
|
| 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 |
$10,442.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,355.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,006.23
|
| 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 |
$9,136.75 |
| 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
|
|
