|
MULTI-LINK 8LL STENT 3*33
|
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
|
|
|
MULTI-LINK 8 LL STENT 3*38
|
Facility
|
OP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem Medicaid |
$1,406.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Humana KY Medicaid |
$1,406.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
MULTI-LINK 8 LL STENT 3*38
|
Facility
|
IP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
MULTI-LINK 8 LL STENT 3.5*33
|
Facility
|
OP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem Medicaid |
$1,731.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Humana KY Medicaid |
$1,731.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
MULTI-LINK 8 LL STENT 3.5*33
|
Facility
|
IP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
MULTI-LINK 8 LL STENT 3.5*38
|
Facility
|
IP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
MULTI-LINK 8 LL STENT 3.5*38
|
Facility
|
OP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem Medicaid |
$1,406.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Humana KY Medicaid |
$1,406.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
MULTI-LINK 8 LL STENT 4*33
|
Facility
|
OP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem Medicaid |
$1,731.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Humana KY Medicaid |
$1,731.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
MULTI-LINK 8 LL STENT 4*33
|
Facility
|
IP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
MULTI-LINK 8 LL STENT 4*38
|
Facility
|
IP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
MULTI-LINK 8 LL STENT 4*38
|
Facility
|
OP
|
$5,035.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.55 |
| Max. Negotiated Rate |
$4,833.60 |
| Rate for Payer: Aetna Commercial |
$3,876.95
|
| Rate for Payer: Anthem Medicaid |
$1,731.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,927.30
|
| Rate for Payer: Cash Price |
$2,517.50
|
| Rate for Payer: Cigna Commercial |
$4,179.05
|
| Rate for Payer: First Health Commercial |
$4,783.25
|
| Rate for Payer: Humana Commercial |
$4,279.75
|
| Rate for Payer: Humana KY Medicaid |
$1,731.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,749.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,128.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,715.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,766.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,430.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,560.85
|
| Rate for Payer: PHCS Commercial |
$4,833.60
|
| Rate for Payer: United Healthcare All Payer |
$4,430.80
|
|
|
MULTI LINK RX ULTRA STENT 5*13
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LINK RX ULTRA STENT 5*13
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LINK RX ULTRA STENT 5*18
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LINK RX ULTRA STENT 5*18
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LINK RX ULTRA STENT 5*28
|
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
|
|
|
MULTI LINK RX ULTRA STENT 5*28
|
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
|
|
|
MULTI LINK RX ULTRA STENT 5*38
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
MULTI LINK RX ULTRA STENT 5*38
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
MULTI LNK RX ULTRA STNT 4.5*13
|
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
|
|
|
MULTI LNK RX ULTRA STNT 4.5*13
|
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
|
|
|
MULTI LNK RX ULTRA STNT 4.5*18
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LNK RX ULTRA STNT 4.5*18
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LNK RX ULTRA STNT 4.5*28
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
MULTI LNK RX ULTRA STNT 4.5*28
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
