|
PROTAMINESULFA10MG(250 MG/10ML
|
Facility
|
IP
|
$321.91
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25002332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$309.03 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.09
|
| Rate for Payer: Cash Price |
$160.96
|
| Rate for Payer: Cigna Commercial |
$267.19
|
| Rate for Payer: First Health Commercial |
$305.81
|
| Rate for Payer: Humana Commercial |
$273.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.28
|
| Rate for Payer: Ohio Health Group HMO |
$241.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.79
|
| Rate for Payer: PHCS Commercial |
$309.03
|
| Rate for Payer: United Healthcare All Payer |
$283.28
|
|
|
PROTAMINESULFA10MG(250 MG/10ML
|
Facility
|
OP
|
$321.91
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25002332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$309.03 |
| Rate for Payer: Aetna Commercial |
$247.87
|
| Rate for Payer: Anthem Medicaid |
$110.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.09
|
| Rate for Payer: Cash Price |
$160.96
|
| Rate for Payer: Cigna Commercial |
$267.19
|
| Rate for Payer: First Health Commercial |
$305.81
|
| Rate for Payer: Humana Commercial |
$273.62
|
| Rate for Payer: Humana KY Medicaid |
$110.70
|
| Rate for Payer: Kentucky WC Medicaid |
$111.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.28
|
| Rate for Payer: Ohio Health Group HMO |
$241.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.79
|
| Rate for Payer: PHCS Commercial |
$309.03
|
| Rate for Payer: United Healthcare All Payer |
$283.28
|
|
|
PROTAMINE SULFATE 50 50MG/5ML
|
Facility
|
OP
|
$122.48
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25003389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Aetna Commercial |
$94.31
|
| Rate for Payer: Anthem Medicaid |
$42.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.53
|
| Rate for Payer: Cash Price |
$61.24
|
| Rate for Payer: Cigna Commercial |
$101.66
|
| Rate for Payer: First Health Commercial |
$116.36
|
| Rate for Payer: Humana Commercial |
$104.11
|
| Rate for Payer: Humana KY Medicaid |
$42.12
|
| Rate for Payer: Kentucky WC Medicaid |
$42.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.78
|
| Rate for Payer: Ohio Health Group HMO |
$91.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.97
|
| Rate for Payer: PHCS Commercial |
$117.58
|
| Rate for Payer: United Healthcare All Payer |
$107.78
|
|
|
PROTAMINE SULFATE 50 50MG/5ML
|
Facility
|
IP
|
$122.48
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
25003389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Aetna Commercial |
$94.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.53
|
| Rate for Payer: Cash Price |
$61.24
|
| Rate for Payer: Cigna Commercial |
$101.66
|
| Rate for Payer: First Health Commercial |
$116.36
|
| Rate for Payer: Humana Commercial |
$104.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.78
|
| Rate for Payer: Ohio Health Group HMO |
$91.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.97
|
| Rate for Payer: PHCS Commercial |
$117.58
|
| Rate for Payer: United Healthcare All Payer |
$107.78
|
|
|
PROTECT AND SERVE TINT 30SPF
|
Professional
|
Both
|
$65.00
|
|
| Hospital Charge Code |
22200131
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
|
|
PROTECTIVE SHEATH
|
Facility
|
OP
|
$537.58
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$516.08 |
| Rate for Payer: Aetna Commercial |
$413.94
|
| Rate for Payer: Anthem Medicaid |
$184.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$419.31
|
| Rate for Payer: Cash Price |
$268.79
|
| Rate for Payer: Cigna Commercial |
$446.19
|
| Rate for Payer: First Health Commercial |
$510.70
|
| Rate for Payer: Humana Commercial |
$456.94
|
| Rate for Payer: Humana KY Medicaid |
$184.87
|
| Rate for Payer: Kentucky WC Medicaid |
$186.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$473.07
|
| Rate for Payer: Ohio Health Group HMO |
$403.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.65
|
| Rate for Payer: PHCS Commercial |
$516.08
|
| Rate for Payer: United Healthcare All Payer |
$473.07
|
|
|
PROTECTIVE SHEATH
|
Facility
|
IP
|
$537.58
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$516.08 |
| Rate for Payer: Aetna Commercial |
$413.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$419.31
|
| Rate for Payer: Cash Price |
$268.79
|
| Rate for Payer: Cigna Commercial |
$446.19
|
| Rate for Payer: First Health Commercial |
$510.70
|
| Rate for Payer: Humana Commercial |
$456.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$473.07
|
| Rate for Payer: Ohio Health Group HMO |
$403.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.65
|
| Rate for Payer: PHCS Commercial |
$516.08
|
| Rate for Payer: United Healthcare All Payer |
$473.07
|
|
|
PROTECT&SERVE UNTINTED 30 SPF
|
Professional
|
Both
|
$65.00
|
|
| Hospital Charge Code |
22200139
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
|
|
PROTEGE 6*200
|
Facility
|
IP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
PROTEGE 6*200
|
Facility
|
OP
|
$16,782.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,181.66 |
| Max. Negotiated Rate |
$16,110.72 |
| Rate for Payer: Aetna Commercial |
$12,922.14
|
| Rate for Payer: Anthem Medicaid |
$5,771.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,089.96
|
| Rate for Payer: Cash Price |
$8,391.00
|
| Rate for Payer: Cigna Commercial |
$13,929.06
|
| Rate for Payer: First Health Commercial |
$15,942.90
|
| Rate for Payer: Humana Commercial |
$14,264.70
|
| Rate for Payer: Humana KY Medicaid |
$5,771.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,830.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,761.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,385.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,034.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,887.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$12,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,181.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,202.42
|
| Rate for Payer: PHCS Commercial |
$16,110.72
|
| Rate for Payer: United Healthcare All Payer |
$14,768.16
|
|
|
PROTEGE 7*200
|
Facility
|
OP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem Medicaid |
$4,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Humana KY Medicaid |
$4,141.16
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
PROTEGE 7*200
|
Facility
|
IP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
PROTEGE EF STENT LNG 6*120*120
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 6*120*120
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 7*100*120
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 7*100*120
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 7*120*120
|
Facility
|
IP
|
$8,625.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.30 |
| Max. Negotiated Rate |
$8,280.38 |
| Rate for Payer: Aetna Commercial |
$6,641.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,727.81
|
| Rate for Payer: Cash Price |
$4,312.70
|
| Rate for Payer: Cigna Commercial |
$7,159.08
|
| Rate for Payer: First Health Commercial |
$8,194.13
|
| Rate for Payer: Humana Commercial |
$7,331.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,072.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,365.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,590.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,469.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.87
|
| Rate for Payer: PHCS Commercial |
$8,280.38
|
| Rate for Payer: United Healthcare All Payer |
$7,590.35
|
|
|
PROTEGE EF STENT LNG 7*120*120
|
Facility
|
OP
|
$8,625.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.30 |
| Max. Negotiated Rate |
$8,280.38 |
| Rate for Payer: Aetna Commercial |
$6,641.56
|
| Rate for Payer: Anthem Medicaid |
$2,966.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,727.81
|
| Rate for Payer: Cash Price |
$4,312.70
|
| Rate for Payer: Cigna Commercial |
$7,159.08
|
| Rate for Payer: First Health Commercial |
$8,194.13
|
| Rate for Payer: Humana Commercial |
$7,331.59
|
| Rate for Payer: Humana KY Medicaid |
$2,966.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,996.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,072.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,365.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,025.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,590.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,469.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.87
|
| Rate for Payer: PHCS Commercial |
$8,280.38
|
| Rate for Payer: United Healthcare All Payer |
$7,590.35
|
|
|
PROTEGE EF STENT LNG 8*120*120
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 8*120*120
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 8*150*120
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LNG 8*150*120
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PROTEGE EF STENT LONG 6*100*12
|
Facility
|
OP
|
$11,238.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.04 |
| Max. Negotiated Rate |
$10,789.20 |
| Rate for Payer: Aetna Commercial |
$8,653.84
|
| Rate for Payer: Anthem Medicaid |
$3,865.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,766.22
|
| Rate for Payer: Cash Price |
$5,619.38
|
| Rate for Payer: Cigna Commercial |
$9,328.16
|
| Rate for Payer: First Health Commercial |
$10,676.81
|
| Rate for Payer: Humana Commercial |
$9,552.94
|
| Rate for Payer: Humana KY Medicaid |
$3,865.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,904.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,215.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,294.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,371.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,942.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,890.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,429.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,484.01
|
| Rate for Payer: PHCS Commercial |
$10,789.20
|
| Rate for Payer: United Healthcare All Payer |
$9,890.10
|
|
|
PROTEGE EF STENT LONG 6*100*12
|
Facility
|
IP
|
$11,238.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.04 |
| Max. Negotiated Rate |
$10,789.20 |
| Rate for Payer: Aetna Commercial |
$8,653.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,766.22
|
| Rate for Payer: Cash Price |
$5,619.38
|
| Rate for Payer: Cigna Commercial |
$9,328.16
|
| Rate for Payer: First Health Commercial |
$10,676.81
|
| Rate for Payer: Humana Commercial |
$9,552.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,215.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,294.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,371.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,890.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,429.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,484.01
|
| Rate for Payer: PHCS Commercial |
$10,789.20
|
| Rate for Payer: United Healthcare All Payer |
$9,890.10
|
|
|
PROTEGE EF STENT LONG 6*150*12
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
