|
PALMAZ GENESIS STENT 12*70*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*40*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*40*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*50*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*50*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*60*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*60*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 15*70*80
|
Facility
|
OP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem Medicaid |
$1,737.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Humana KY Medicaid |
$1,737.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,772.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ GENESIS STENT 15*70*80
|
Facility
|
IP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ GENESIS STENT 18*40*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*40*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*50*80
|
Facility
|
IP
|
$4,854.69
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.41 |
| Max. Negotiated Rate |
$4,660.50 |
| Rate for Payer: Aetna Commercial |
$3,738.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.66
|
| Rate for Payer: Cash Price |
$2,427.34
|
| Rate for Payer: Cigna Commercial |
$4,029.39
|
| Rate for Payer: First Health Commercial |
$4,611.96
|
| Rate for Payer: Humana Commercial |
$4,126.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,883.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.74
|
| Rate for Payer: PHCS Commercial |
$4,660.50
|
| Rate for Payer: United Healthcare All Payer |
$4,272.13
|
|
|
PALMAZ GENESIS STENT 18*50*80
|
Facility
|
OP
|
$4,854.69
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.41 |
| Max. Negotiated Rate |
$4,660.50 |
| Rate for Payer: Aetna Commercial |
$3,738.11
|
| Rate for Payer: Anthem Medicaid |
$1,669.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.66
|
| Rate for Payer: Cash Price |
$2,427.34
|
| Rate for Payer: Cigna Commercial |
$4,029.39
|
| Rate for Payer: First Health Commercial |
$4,611.96
|
| Rate for Payer: Humana Commercial |
$4,126.49
|
| Rate for Payer: Humana KY Medicaid |
$1,669.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,883.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.74
|
| Rate for Payer: PHCS Commercial |
$4,660.50
|
| Rate for Payer: United Healthcare All Payer |
$4,272.13
|
|
|
PALMAZ GENESIS STENT 18*60*135
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*60*135
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*60*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*60*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*70*135
|
Facility
|
OP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem Medicaid |
$1,622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Humana KY Medicaid |
$1,622.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PALMAZ GENESIS STENT 18*70*135
|
Facility
|
IP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PALMAZ GENESIS STENT 18*70*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*70*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*80*135
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*80*135
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 18*80*80
|
Facility
|
OP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem Medicaid |
$1,622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Humana KY Medicaid |
$1,622.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PALMAZ GENESIS STENT 18*80*80
|
Facility
|
IP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
