|
INNOVA 6*80*130 STENT
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 7*100*130 STENT
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 7*100*130 STENT
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 7*120*130 STENT
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 7*120*130 STENT
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem Medicaid |
$1,490.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Humana KY Medicaid |
$1,490.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,505.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,520.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 7*150*130 STENT
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
INNOVA 7*150*130 STENT
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
INNOVA 7*20*130 STENT
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 7*20*130 STENT
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 7*40*130 STENT
|
Facility
|
OP
|
$7,818.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.44 |
| Max. Negotiated Rate |
$7,506.00 |
| Rate for Payer: Aetna Commercial |
$6,020.44
|
| Rate for Payer: Anthem Medicaid |
$2,688.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.62
|
| Rate for Payer: Cash Price |
$3,909.38
|
| Rate for Payer: Cigna Commercial |
$6,489.56
|
| Rate for Payer: First Health Commercial |
$7,427.81
|
| Rate for Payer: Humana Commercial |
$6,645.94
|
| Rate for Payer: Humana KY Medicaid |
$2,688.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,716.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,411.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,770.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,880.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,864.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,423.81
|
| Rate for Payer: PHCS Commercial |
$7,506.00
|
| Rate for Payer: United Healthcare All Payer |
$6,880.50
|
|
|
INNOVA 7*40*130 STENT
|
Facility
|
IP
|
$7,818.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.44 |
| Max. Negotiated Rate |
$7,506.00 |
| Rate for Payer: Aetna Commercial |
$6,020.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.62
|
| Rate for Payer: Cash Price |
$3,909.38
|
| Rate for Payer: Cigna Commercial |
$6,489.56
|
| Rate for Payer: First Health Commercial |
$7,427.81
|
| Rate for Payer: Humana Commercial |
$6,645.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,411.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,770.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,880.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,864.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,423.81
|
| Rate for Payer: PHCS Commercial |
$7,506.00
|
| Rate for Payer: United Healthcare All Payer |
$6,880.50
|
|
|
INNOVA 7*60*130 STENT
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem Medicaid |
$1,490.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Humana KY Medicaid |
$1,490.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,505.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,520.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 7*60*130 STENT
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 7*80*130 STENT
|
Facility
|
OP
|
$7,818.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.44 |
| Max. Negotiated Rate |
$7,506.00 |
| Rate for Payer: Aetna Commercial |
$6,020.44
|
| Rate for Payer: Anthem Medicaid |
$2,688.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.62
|
| Rate for Payer: Cash Price |
$3,909.38
|
| Rate for Payer: Cigna Commercial |
$6,489.56
|
| Rate for Payer: First Health Commercial |
$7,427.81
|
| Rate for Payer: Humana Commercial |
$6,645.94
|
| Rate for Payer: Humana KY Medicaid |
$2,688.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,716.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,411.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,770.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,880.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,864.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,423.81
|
| Rate for Payer: PHCS Commercial |
$7,506.00
|
| Rate for Payer: United Healthcare All Payer |
$6,880.50
|
|
|
INNOVA 7*80*130 STENT
|
Facility
|
IP
|
$7,818.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.44 |
| Max. Negotiated Rate |
$7,506.00 |
| Rate for Payer: Aetna Commercial |
$6,020.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.62
|
| Rate for Payer: Cash Price |
$3,909.38
|
| Rate for Payer: Cigna Commercial |
$6,489.56
|
| Rate for Payer: First Health Commercial |
$7,427.81
|
| Rate for Payer: Humana Commercial |
$6,645.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,411.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,770.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,880.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,864.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,423.81
|
| Rate for Payer: PHCS Commercial |
$7,506.00
|
| Rate for Payer: United Healthcare All Payer |
$6,880.50
|
|
|
INNOVA 8*100*130 STENT
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*100*130 STENT
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*120*130 STENT
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*120*130 STENT
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*150*130 STENT
|
Facility
|
OP
|
$4,685.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.05 |
| Max. Negotiated Rate |
$4,497.60 |
| Rate for Payer: Aetna Commercial |
$3,607.45
|
| Rate for Payer: Anthem Medicaid |
$1,611.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.30
|
| Rate for Payer: Cash Price |
$2,342.50
|
| Rate for Payer: Cigna Commercial |
$3,888.55
|
| Rate for Payer: First Health Commercial |
$4,450.75
|
| Rate for Payer: Humana Commercial |
$3,982.25
|
| Rate for Payer: Humana KY Medicaid |
$1,611.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,627.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,841.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,457.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,643.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,122.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.35
|
| Rate for Payer: PHCS Commercial |
$4,497.60
|
| Rate for Payer: United Healthcare All Payer |
$4,122.80
|
|
|
INNOVA 8*150*130 STENT
|
Facility
|
IP
|
$4,685.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.05 |
| Max. Negotiated Rate |
$4,497.60 |
| Rate for Payer: Aetna Commercial |
$3,607.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.30
|
| Rate for Payer: Cash Price |
$2,342.50
|
| Rate for Payer: Cigna Commercial |
$3,888.55
|
| Rate for Payer: First Health Commercial |
$4,450.75
|
| Rate for Payer: Humana Commercial |
$3,982.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,841.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,457.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,122.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.35
|
| Rate for Payer: PHCS Commercial |
$4,497.60
|
| Rate for Payer: United Healthcare All Payer |
$4,122.80
|
|
|
INNOVA 8*20*130 STENT
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*20*130 STENT
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*40*130 STENT
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem Medicaid |
$1,490.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Humana KY Medicaid |
$1,490.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,505.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,520.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 8*40*130 STENT
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
