|
INNOVA 7*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 7*150*130 STENT
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
INNOVA 7*150*130 STENT
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
INNOVA 7*20*130 STENT
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
INNOVA 7*20*130 STENT
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
INNOVA 7*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 7*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 7*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 7*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 7*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 7*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 8*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 8*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 8*120*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 8*120*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 8*150*130 STENT
|
Facility
|
IP
|
$4,662.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.75 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$3,590.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,636.75
|
| Rate for Payer: Cash Price |
$2,331.25
|
| Rate for Payer: Cigna Commercial |
$3,869.88
|
| Rate for Payer: First Health Commercial |
$4,429.38
|
| Rate for Payer: Humana Commercial |
$3,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,440.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,103.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,496.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,056.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,217.12
|
| Rate for Payer: PHCS Commercial |
$4,476.00
|
| Rate for Payer: United Healthcare All Payer |
$4,103.00
|
|
|
INNOVA 8*150*130 STENT
|
Facility
|
OP
|
$4,662.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.75 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$3,590.12
|
| Rate for Payer: Anthem Medicaid |
$1,603.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,636.75
|
| Rate for Payer: Cash Price |
$2,331.25
|
| Rate for Payer: Cigna Commercial |
$3,869.88
|
| Rate for Payer: First Health Commercial |
$4,429.38
|
| Rate for Payer: Humana Commercial |
$3,963.12
|
| Rate for Payer: Humana KY Medicaid |
$1,603.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,619.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,440.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,635.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,103.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,496.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,056.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,217.12
|
| Rate for Payer: PHCS Commercial |
$4,476.00
|
| Rate for Payer: United Healthcare All Payer |
$4,103.00
|
|
|
INNOVA 8*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 8*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 8*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 8*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 8*60*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 8*60*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 8*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 8*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
|
|
