|
PRQ CARD STENT/ATH/ANGIO
|
Facility
|
IP
|
$25,698.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,709.40 |
| Max. Negotiated Rate |
$24,670.08 |
| Rate for Payer: Aetna Commercial |
$19,787.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,044.44
|
| Rate for Payer: Cash Price |
$12,849.00
|
| Rate for Payer: Cigna Commercial |
$21,329.34
|
| Rate for Payer: First Health Commercial |
$24,413.10
|
| Rate for Payer: Humana Commercial |
$21,843.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,072.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,965.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,709.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,614.24
|
| Rate for Payer: Ohio Health Group HMO |
$19,273.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,357.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,731.62
|
| Rate for Payer: PHCS Commercial |
$24,670.08
|
| Rate for Payer: United Healthcare All Payer |
$22,614.24
|
|
|
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 |
$14,448.60 |
| Rate for Payer: Ambetter Exchange |
$615.63
|
| Rate for Payer: Anthem Medicaid |
$540.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$615.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$738.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$615.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.63
|
| 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 |
$800.32
|
| Rate for Payer: UHCCP Medicaid |
$8,428.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$545.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$615.63
|
|
|
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 |
$8,281.46 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$18,542.37
|
| Rate for Payer: Anthem Medicaid |
$8,281.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,783.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| 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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$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
|
$15,032.00
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,509.60 |
| 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 |
$12,025.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,077.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,372.08
|
| 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
|
$25,698.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
48100050
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,837.54 |
| Max. Negotiated Rate |
$24,670.08 |
| Rate for Payer: Aetna Commercial |
$19,787.46
|
| Rate for Payer: Anthem Medicaid |
$8,837.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,044.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$12,849.00
|
| Rate for Payer: Cash Price |
$12,849.00
|
| Rate for Payer: Cigna Commercial |
$21,329.34
|
| Rate for Payer: First Health Commercial |
$24,413.10
|
| Rate for Payer: Humana Commercial |
$21,843.30
|
| Rate for Payer: Humana KY Medicaid |
$8,837.54
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$8,927.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,072.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,965.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,014.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,614.24
|
| Rate for Payer: Ohio Health Group HMO |
$19,273.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,357.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,731.62
|
| Rate for Payer: PHCS Commercial |
$24,670.08
|
| Rate for Payer: United Healthcare All Payer |
$22,614.24
|
|
|
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 |
$4,509.60 |
| 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 |
$12,025.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,077.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,372.08
|
| Rate for Payer: PHCS Commercial |
$14,430.72
|
| Rate for Payer: United Healthcare All Payer |
$13,228.16
|
|
|
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 |
$1,200.51 |
| Rate for Payer: Ambetter Exchange |
$615.63
|
| Rate for Payer: Anthem Medicaid |
$540.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$615.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$738.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$615.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.63
|
| 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 |
$800.32
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$545.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$615.63
|
|
|
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 |
$700.00 |
| 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 |
$7,851.58 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$17,579.87
|
| Rate for Payer: Anthem Medicaid |
$7,851.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,808.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| 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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$18,264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,862.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,753.39
|
| 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
|
OP
|
$12,052.50
|
|
|
Service Code
|
HCPCS 92934
|
| Hospital Charge Code |
761T2460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,615.75 |
| Max. Negotiated Rate |
$11,570.40 |
| Rate for Payer: Aetna Commercial |
$9,280.42
|
| Rate for Payer: Anthem Medicaid |
$4,144.85
|
| 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: Humana KY Medicaid |
$4,144.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,187.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,883.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,894.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,615.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,228.02
|
| 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 |
$9,642.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,485.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,316.23
|
| Rate for Payer: PHCS Commercial |
$11,570.40
|
| Rate for Payer: United Healthcare All Payer |
$10,606.20
|
|
|
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 |
$3,615.75 |
| 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 |
$8,894.75
|
| 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 |
$9,642.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,485.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,316.23
|
| Rate for Payer: PHCS Commercial |
$11,570.40
|
| Rate for Payer: United Healthcare All Payer |
$10,606.20
|
|
|
PRQ CARD STENT/ATH/ANGIO(T
|
Facility
|
IP
|
$22,831.00
|
|
|
Service Code
|
HCPCS 92933
|
| Hospital Charge Code |
761T2459
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,849.30 |
| Max. Negotiated Rate |
$21,917.76 |
| Rate for Payer: Aetna Commercial |
$17,579.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,808.18
|
| 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: 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 |
$6,849.30
|
| 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 |
$18,264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,862.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,753.39
|
| Rate for Payer: PHCS Commercial |
$21,917.76
|
| Rate for Payer: United Healthcare All Payer |
$20,091.28
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Professional
|
Both
|
$20,109.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
76102457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.06 |
| Max. Negotiated Rate |
$12,065.93 |
| Rate for Payer: Ambetter Exchange |
$548.36
|
| Rate for Payer: Anthem Medicaid |
$483.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$658.03
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: Healthspan PPO |
$711.33
|
| Rate for Payer: Humana Medicaid |
$483.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.72
|
| Rate for Payer: Molina Healthcare Passport |
$483.06
|
| Rate for Payer: Multiplan PHCS |
$12,065.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$712.87
|
| Rate for Payer: UHCCP Medicaid |
$7,038.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.36
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
IP
|
$20,109.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
76102457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,032.96 |
| Max. Negotiated Rate |
$19,305.48 |
| Rate for Payer: Aetna Commercial |
$15,484.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,685.71
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cigna Commercial |
$16,691.20
|
| Rate for Payer: First Health Commercial |
$19,104.39
|
| Rate for Payer: Humana Commercial |
$17,093.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,490.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,841.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,032.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,696.69
|
| Rate for Payer: Ohio Health Group HMO |
$15,082.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,087.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,495.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,875.82
|
| Rate for Payer: PHCS Commercial |
$19,305.48
|
| Rate for Payer: United Healthcare All Payer |
$17,696.69
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
IP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
48100048
|
|
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 STENT W/ANGIO 1 VSL
|
Facility
|
OP
|
$20,109.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
76102457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,915.79 |
| Max. Negotiated Rate |
$19,305.48 |
| Rate for Payer: Aetna Commercial |
$15,484.61
|
| Rate for Payer: Anthem Medicaid |
$6,915.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,685.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cash Price |
$10,054.94
|
| Rate for Payer: Cigna Commercial |
$16,691.20
|
| Rate for Payer: First Health Commercial |
$19,104.39
|
| Rate for Payer: Humana Commercial |
$17,093.40
|
| Rate for Payer: Humana KY Medicaid |
$6,915.79
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$6,986.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,490.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,841.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,054.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,696.69
|
| Rate for Payer: Ohio Health Group HMO |
$15,082.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,087.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,495.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,875.82
|
| Rate for Payer: PHCS Commercial |
$19,305.48
|
| Rate for Payer: United Healthcare All Payer |
$17,696.69
|
|
|
PRQ CARD STENT W/ANGIO 1 VSL
|
Facility
|
OP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
48100048
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,057.80 |
| Max. Negotiated Rate |
$16,910.40 |
| Rate for Payer: Aetna Commercial |
$13,563.55
|
| Rate for Payer: Anthem Medicaid |
$6,057.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,739.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cash Price |
$8,807.50
|
| Rate for Payer: Cigna Commercial |
$14,620.45
|
| Rate for Payer: First Health Commercial |
$16,734.25
|
| Rate for Payer: Humana Commercial |
$14,972.75
|
| Rate for Payer: Humana KY Medicaid |
$6,057.80
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$6,119.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,999.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,179.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,501.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,211.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,325.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,154.35
|
| Rate for Payer: PHCS Commercial |
$16,910.40
|
| Rate for Payer: United Healthcare All Payer |
$15,501.20
|
|
|
PRQ CARD STENT W/ANGIO 1 VS(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
761P2457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.50 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Ambetter Exchange |
$548.36
|
| Rate for Payer: Anthem Medicaid |
$483.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$658.03
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: Healthspan PPO |
$711.33
|
| Rate for Payer: Humana Medicaid |
$483.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$492.72
|
| Rate for Payer: Molina Healthcare Passport |
$483.06
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$712.87
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$487.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.36
|
|
|
PRQ CARD STENT W/ANGIO 1 VS(T
|
Facility
|
OP
|
$18,959.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
761T2457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,520.30 |
| Max. Negotiated Rate |
$18,201.48 |
| Rate for Payer: Aetna Commercial |
$14,599.11
|
| Rate for Payer: Anthem Medicaid |
$6,520.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,788.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cigna Commercial |
$15,736.70
|
| Rate for Payer: First Health Commercial |
$18,011.89
|
| Rate for Payer: Humana Commercial |
$16,115.90
|
| Rate for Payer: Humana KY Medicaid |
$6,520.30
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$6,586.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,547.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,992.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,651.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,684.69
|
| Rate for Payer: Ohio Health Group HMO |
$14,219.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,167.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,495.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,082.32
|
| Rate for Payer: PHCS Commercial |
$18,201.48
|
| Rate for Payer: United Healthcare All Payer |
$16,684.69
|
|
|
PRQ CARD STENT W/ANGIO 1 VS(T
|
Facility
|
IP
|
$18,959.88
|
|
|
Service Code
|
HCPCS 92928
|
| Hospital Charge Code |
761T2457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,687.96 |
| Max. Negotiated Rate |
$18,201.48 |
| Rate for Payer: Aetna Commercial |
$14,599.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,788.71
|
| Rate for Payer: Cash Price |
$9,479.94
|
| Rate for Payer: Cigna Commercial |
$15,736.70
|
| Rate for Payer: First Health Commercial |
$18,011.89
|
| Rate for Payer: Humana Commercial |
$16,115.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,547.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,992.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,687.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,684.69
|
| Rate for Payer: Ohio Health Group HMO |
$14,219.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,167.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,495.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,082.32
|
| Rate for Payer: PHCS Commercial |
$18,201.48
|
| Rate for Payer: United Healthcare All Payer |
$16,684.69
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
OP
|
$15,829.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
76102458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,748.70 |
| Max. Negotiated Rate |
$15,195.84 |
| Rate for Payer: Aetna Commercial |
$12,188.33
|
| Rate for Payer: Anthem Medicaid |
$5,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.62
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Cigna Commercial |
$13,138.07
|
| Rate for Payer: First Health Commercial |
$15,037.55
|
| Rate for Payer: Humana Commercial |
$13,454.65
|
| Rate for Payer: Humana KY Medicaid |
$5,443.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,771.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,922.01
|
| Rate for Payer: PHCS Commercial |
$15,195.84
|
| Rate for Payer: United Healthcare All Payer |
$13,929.52
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
OP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
48100049
|
|
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 STENT W/ANGIO ADDL
|
Professional
|
Both
|
$15,829.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
76102458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$11,080.30 |
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$9,497.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,080.30
|
| Rate for Payer: UHCCP Medicaid |
$5,540.15
|
|
|
PRQ CARD STENT W/ANGIO ADDL
|
Facility
|
IP
|
$17,615.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
48100049
|
|
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 STENT W/ANGIO ADDL
|
Facility
|
IP
|
$15,829.00
|
|
|
Service Code
|
HCPCS 92929
|
| Hospital Charge Code |
76102458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,748.70 |
| Max. Negotiated Rate |
$15,195.84 |
| Rate for Payer: Aetna Commercial |
$12,188.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.62
|
| Rate for Payer: Cash Price |
$7,914.50
|
| Rate for Payer: Cigna Commercial |
$13,138.07
|
| Rate for Payer: First Health Commercial |
$15,037.55
|
| Rate for Payer: Humana Commercial |
$13,454.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,771.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,922.01
|
| Rate for Payer: PHCS Commercial |
$15,195.84
|
| Rate for Payer: United Healthcare All Payer |
$13,929.52
|
|
