|
INNOVA 5*20*130 STENT
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 5*20*130 STENT
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 5*40*130 STENT
|
Facility
|
OP
|
$8,018.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.62 |
| Max. Negotiated Rate |
$7,698.00 |
| Rate for Payer: Aetna Commercial |
$6,174.44
|
| Rate for Payer: Anthem Medicaid |
$2,757.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,254.62
|
| Rate for Payer: Cash Price |
$4,009.38
|
| Rate for Payer: Cigna Commercial |
$6,655.56
|
| Rate for Payer: First Health Commercial |
$7,617.81
|
| Rate for Payer: Humana Commercial |
$6,815.94
|
| Rate for Payer: Humana KY Medicaid |
$2,757.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,785.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,917.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,812.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,056.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,976.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,532.94
|
| Rate for Payer: PHCS Commercial |
$7,698.00
|
| Rate for Payer: United Healthcare All Payer |
$7,056.50
|
|
|
INNOVA 5*40*130 STENT
|
Facility
|
IP
|
$8,018.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.62 |
| Max. Negotiated Rate |
$7,698.00 |
| Rate for Payer: Aetna Commercial |
$6,174.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,254.62
|
| Rate for Payer: Cash Price |
$4,009.38
|
| Rate for Payer: Cigna Commercial |
$6,655.56
|
| Rate for Payer: First Health Commercial |
$7,617.81
|
| Rate for Payer: Humana Commercial |
$6,815.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,917.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,056.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,976.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,532.94
|
| Rate for Payer: PHCS Commercial |
$7,698.00
|
| Rate for Payer: United Healthcare All Payer |
$7,056.50
|
|
|
INNOVA 5*60*130 STENT
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 5*60*130 STENT
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 5*80*130 STENT
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 5*80*130 STENT
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 6*100*130 STENT
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 6*100*130 STENT
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 6*120*130 STENT
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
INNOVA 6*120*130 STENT
|
Facility
|
IP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
INNOVA 6*150*130 STENT
|
Facility
|
IP
|
$10,950.10
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,285.03 |
| Max. Negotiated Rate |
$10,512.10 |
| Rate for Payer: Aetna Commercial |
$8,431.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.08
|
| Rate for Payer: Cash Price |
$5,475.05
|
| Rate for Payer: Cigna Commercial |
$9,088.58
|
| Rate for Payer: First Health Commercial |
$10,402.59
|
| Rate for Payer: Humana Commercial |
$9,307.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,760.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,526.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,555.57
|
| Rate for Payer: PHCS Commercial |
$10,512.10
|
| Rate for Payer: United Healthcare All Payer |
$9,636.09
|
|
|
INNOVA 6*150*130 STENT
|
Facility
|
OP
|
$10,950.10
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,285.03 |
| Max. Negotiated Rate |
$10,512.10 |
| Rate for Payer: Aetna Commercial |
$8,431.58
|
| Rate for Payer: Anthem Medicaid |
$3,765.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.08
|
| Rate for Payer: Cash Price |
$5,475.05
|
| Rate for Payer: Cigna Commercial |
$9,088.58
|
| Rate for Payer: First Health Commercial |
$10,402.59
|
| Rate for Payer: Humana Commercial |
$9,307.58
|
| Rate for Payer: Humana KY Medicaid |
$3,765.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,760.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,526.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,555.57
|
| Rate for Payer: PHCS Commercial |
$10,512.10
|
| Rate for Payer: United Healthcare All Payer |
$9,636.09
|
|
|
INNOVA 6*20*130 STENT
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 6*20*130 STENT
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 6*40*130 STENT
|
Facility
|
IP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
INNOVA 6*40*130 STENT
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
INNOVA 6*60*130 STENT
|
Facility
|
IP
|
$8,018.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.62 |
| Max. Negotiated Rate |
$7,698.00 |
| Rate for Payer: Aetna Commercial |
$6,174.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,254.62
|
| Rate for Payer: Cash Price |
$4,009.38
|
| Rate for Payer: Cigna Commercial |
$6,655.56
|
| Rate for Payer: First Health Commercial |
$7,617.81
|
| Rate for Payer: Humana Commercial |
$6,815.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,917.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,056.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,976.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,532.94
|
| Rate for Payer: PHCS Commercial |
$7,698.00
|
| Rate for Payer: United Healthcare All Payer |
$7,056.50
|
|
|
INNOVA 6*60*130 STENT
|
Facility
|
OP
|
$8,018.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.62 |
| Max. Negotiated Rate |
$7,698.00 |
| Rate for Payer: Aetna Commercial |
$6,174.44
|
| Rate for Payer: Anthem Medicaid |
$2,757.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,254.62
|
| Rate for Payer: Cash Price |
$4,009.38
|
| Rate for Payer: Cigna Commercial |
$6,655.56
|
| Rate for Payer: First Health Commercial |
$7,617.81
|
| Rate for Payer: Humana Commercial |
$6,815.94
|
| Rate for Payer: Humana KY Medicaid |
$2,757.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,785.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,917.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,812.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,056.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,976.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,532.94
|
| Rate for Payer: PHCS Commercial |
$7,698.00
|
| Rate for Payer: United Healthcare All Payer |
$7,056.50
|
|
|
INNOVA 6*80*130 STENT
|
Facility
|
IP
|
$8,018.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.62 |
| Max. Negotiated Rate |
$7,698.00 |
| Rate for Payer: Aetna Commercial |
$6,174.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,254.62
|
| Rate for Payer: Cash Price |
$4,009.38
|
| Rate for Payer: Cigna Commercial |
$6,655.56
|
| Rate for Payer: First Health Commercial |
$7,617.81
|
| Rate for Payer: Humana Commercial |
$6,815.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,917.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,056.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,976.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,532.94
|
| Rate for Payer: PHCS Commercial |
$7,698.00
|
| Rate for Payer: United Healthcare All Payer |
$7,056.50
|
|
|
INNOVA 6*80*130 STENT
|
Facility
|
OP
|
$8,018.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.62 |
| Max. Negotiated Rate |
$7,698.00 |
| Rate for Payer: Aetna Commercial |
$6,174.44
|
| Rate for Payer: Anthem Medicaid |
$2,757.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,254.62
|
| Rate for Payer: Cash Price |
$4,009.38
|
| Rate for Payer: Cigna Commercial |
$6,655.56
|
| Rate for Payer: First Health Commercial |
$7,617.81
|
| Rate for Payer: Humana Commercial |
$6,815.94
|
| Rate for Payer: Humana KY Medicaid |
$2,757.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,785.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,917.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,812.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,056.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,976.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,532.94
|
| Rate for Payer: PHCS Commercial |
$7,698.00
|
| Rate for Payer: United Healthcare All Payer |
$7,056.50
|
|
|
INNOVA 7*100*130 STENT
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 7*100*130 STENT
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
INNOVA 7*120*130 STENT
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
