|
INTEGRITY STENT 3.50 * 15
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 3.50 * 18
|
Facility
|
IP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
INTEGRITY STENT 3.50 * 18
|
Facility
|
OP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem Medicaid |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Humana KY Medicaid |
$1,448.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
INTEGRITY STENT 3.50 * 22
|
Facility
|
OP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem Medicaid |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Humana KY Medicaid |
$1,448.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
INTEGRITY STENT 3.50 * 22
|
Facility
|
IP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
INTEGRITY STENT 3.50 * 26
|
Facility
|
OP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem Medicaid |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Humana KY Medicaid |
$1,448.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
INTEGRITY STENT 3.50 * 26
|
Facility
|
IP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.62 |
| Max. Negotiated Rate |
$4,044.00 |
| Rate for Payer: Aetna Commercial |
$3,243.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,285.75
|
| Rate for Payer: Cash Price |
$2,106.25
|
| Rate for Payer: Cigna Commercial |
$3,496.38
|
| Rate for Payer: First Health Commercial |
$4,001.88
|
| Rate for Payer: Humana Commercial |
$3,580.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,454.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,707.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,159.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.88
|
| Rate for Payer: PHCS Commercial |
$4,044.00
|
| Rate for Payer: United Healthcare All Payer |
$3,707.00
|
|
|
INTEGRITY STENT 3.50 * 30
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
INTEGRITY STENT 3.50 * 30
|
Facility
|
IP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
INTEGRITY STENT 3.50 * 9
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
INTEGRITY STENT 3.50 * 9
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
INTEGRITY STENT 4.00 * 12
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
INTEGRITY STENT 4.00 * 12
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
INTEGRITY STENT 4.00 * 15
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 15
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 18
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 18
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 22
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 22
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 26
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 26
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 30
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 30
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 9
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
INTEGRITY STENT 4.00 * 9
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
