|
IABP OPEN
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
48100005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$654.30 |
| Max. Negotiated Rate |
$2,093.76 |
| Rate for Payer: Aetna Commercial |
$1,679.37
|
| Rate for Payer: Anthem Medicaid |
$750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.18
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$1,810.23
|
| Rate for Payer: First Health Commercial |
$2,071.95
|
| Rate for Payer: Humana Commercial |
$1,853.85
|
| Rate for Payer: Humana KY Medicaid |
$750.05
|
| Rate for Payer: Kentucky WC Medicaid |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,788.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,919.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,897.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.89
|
| Rate for Payer: PHCS Commercial |
$2,093.76
|
| Rate for Payer: United Healthcare All Payer |
$1,919.28
|
|
|
IABP OPEN
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
48100005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$654.30 |
| Max. Negotiated Rate |
$2,093.76 |
| Rate for Payer: Aetna Commercial |
$1,679.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.18
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$1,810.23
|
| Rate for Payer: First Health Commercial |
$2,071.95
|
| Rate for Payer: Humana Commercial |
$1,853.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,788.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,919.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,897.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.89
|
| Rate for Payer: PHCS Commercial |
$2,093.76
|
| Rate for Payer: United Healthcare All Payer |
$1,919.28
|
|
|
IABP OPEN
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
76101326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
IABP OPEN
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
76101326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$634.77
|
| Rate for Payer: Ambetter Exchange |
$330.55
|
| Rate for Payer: Anthem Medicaid |
$462.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.66
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$580.26
|
| Rate for Payer: Healthspan PPO |
$624.10
|
| Rate for Payer: Humana Medicaid |
$462.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.00
|
| Rate for Payer: Molina Healthcare Passport |
$462.75
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.71
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$467.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.55
|
|
|
IABP OPEN
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
76101326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
IABP OPEN(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
761P1326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$634.77
|
| Rate for Payer: Ambetter Exchange |
$330.55
|
| Rate for Payer: Anthem Medicaid |
$462.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.66
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$580.26
|
| Rate for Payer: Healthspan PPO |
$624.10
|
| Rate for Payer: Humana Medicaid |
$462.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.00
|
| Rate for Payer: Molina Healthcare Passport |
$462.75
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.71
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$467.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.55
|
|
|
IABP REMOVAL
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 33968
|
| Hospital Charge Code |
76101325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$60.33 |
| Rate for Payer: Aetna Commercial |
$60.33
|
| Rate for Payer: Ambetter Exchange |
$31.90
|
| Rate for Payer: Anthem Medicaid |
$31.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.28
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: Healthspan PPO |
$59.31
|
| Rate for Payer: Humana Medicaid |
$31.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.00
|
| Rate for Payer: Molina Healthcare Passport |
$31.37
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.47
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.90
|
|
|
IABP REMOVAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 33968
|
| Hospital Charge Code |
76101325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
IABP REMOVAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 33968
|
| Hospital Charge Code |
76101325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
IABP REMOVAL
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
HCPCS 33968
|
| Hospital Charge Code |
48100004
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$129.90 |
| Max. Negotiated Rate |
$415.68 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.74
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$359.39
|
| Rate for Payer: First Health Commercial |
$411.35
|
| Rate for Payer: Humana Commercial |
$368.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.04
|
| Rate for Payer: Ohio Health Group HMO |
$324.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.77
|
| Rate for Payer: PHCS Commercial |
$415.68
|
| Rate for Payer: United Healthcare All Payer |
$381.04
|
|
|
IABP REMOVAL
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
HCPCS 33968
|
| Hospital Charge Code |
48100004
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$129.90 |
| Max. Negotiated Rate |
$415.68 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Anthem Medicaid |
$148.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.74
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$359.39
|
| Rate for Payer: First Health Commercial |
$411.35
|
| Rate for Payer: Humana Commercial |
$368.05
|
| Rate for Payer: Humana KY Medicaid |
$148.91
|
| Rate for Payer: Kentucky WC Medicaid |
$150.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$355.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$381.04
|
| Rate for Payer: Ohio Health Group HMO |
$324.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.77
|
| Rate for Payer: PHCS Commercial |
$415.68
|
| Rate for Payer: United Healthcare All Payer |
$381.04
|
|
|
IABP REMOVAL(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 33968
|
| Hospital Charge Code |
761P1325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$60.33 |
| Rate for Payer: Aetna Commercial |
$60.33
|
| Rate for Payer: Ambetter Exchange |
$31.90
|
| Rate for Payer: Anthem Medicaid |
$31.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.28
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: Healthspan PPO |
$59.31
|
| Rate for Payer: Humana Medicaid |
$31.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.00
|
| Rate for Payer: Molina Healthcare Passport |
$31.37
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.47
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.90
|
|
|
I CAST STENT 10*38
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 10*38
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*16*120
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*16*120
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*16*80
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*16*80
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*22*80
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*22*80
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*38
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*38
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*59
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 5*59
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
I CAST STENT 6*16*120
|
Facility
|
OP
|
$13,053.01
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,915.90 |
| Max. Negotiated Rate |
$12,530.89 |
| Rate for Payer: Aetna Commercial |
$10,050.82
|
| Rate for Payer: Anthem Medicaid |
$4,488.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,181.35
|
| Rate for Payer: Cash Price |
$6,526.50
|
| Rate for Payer: Cigna Commercial |
$10,834.00
|
| Rate for Payer: First Health Commercial |
$12,400.36
|
| Rate for Payer: Humana Commercial |
$11,095.06
|
| Rate for Payer: Humana KY Medicaid |
$4,488.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,534.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,703.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,633.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,915.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,579.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,486.65
|
| Rate for Payer: Ohio Health Group HMO |
$9,789.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,356.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,006.58
|
| Rate for Payer: PHCS Commercial |
$12,530.89
|
| Rate for Payer: United Healthcare All Payer |
$11,486.65
|
|
