|
PROTEGE EVERFLEX STENT 7*60*12
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 7*60*12
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 7*60*80
|
Facility
|
OP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem Medicaid |
$2,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Humana KY Medicaid |
$2,358.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,382.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
|
PROTEGE EVERFLEX STENT 7*60*80
|
Facility
|
IP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
|
PROTEGE EVERFLEX STENT 7*80*12
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 7*80*12
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 7*80*80
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 7*80*80
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*20*12
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*20*12
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*20*80
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*20*80
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*30*12
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*30*12
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*40*12
|
Facility
|
IP
|
$9,643.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.69 |
| Max. Negotiated Rate |
$9,258.00 |
| Rate for Payer: Aetna Commercial |
$7,425.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,522.12
|
| Rate for Payer: Cash Price |
$4,821.88
|
| Rate for Payer: Cigna Commercial |
$8,004.31
|
| Rate for Payer: First Health Commercial |
$9,161.56
|
| Rate for Payer: Humana Commercial |
$8,197.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,907.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,117.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,486.50
|
| Rate for Payer: Ohio Health Group HMO |
$7,232.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,928.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.56
|
| Rate for Payer: PHCS Commercial |
$9,258.00
|
| Rate for Payer: United Healthcare All Payer |
$8,486.50
|
|
|
PROTEGE EVERFLEX STENT 8*40*12
|
Facility
|
OP
|
$9,643.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.69 |
| Max. Negotiated Rate |
$9,258.00 |
| Rate for Payer: Aetna Commercial |
$7,425.69
|
| Rate for Payer: Anthem Medicaid |
$3,316.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,522.12
|
| Rate for Payer: Cash Price |
$4,821.88
|
| Rate for Payer: Cigna Commercial |
$8,004.31
|
| Rate for Payer: First Health Commercial |
$9,161.56
|
| Rate for Payer: Humana Commercial |
$8,197.19
|
| Rate for Payer: Humana KY Medicaid |
$3,316.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,907.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,117.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,486.50
|
| Rate for Payer: Ohio Health Group HMO |
$7,232.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,928.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,989.56
|
| Rate for Payer: PHCS Commercial |
$9,258.00
|
| Rate for Payer: United Healthcare All Payer |
$8,486.50
|
|
|
PROTEGE EVERFLEX STENT 8*40*80
|
Facility
|
OP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem Medicaid |
$2,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Humana KY Medicaid |
$2,358.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,382.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
|
PROTEGE EVERFLEX STENT 8*40*80
|
Facility
|
IP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
|
PROTEGE EVERFLEX STENT 8*60*12
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*60*12
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*60*80
|
Facility
|
OP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem Medicaid |
$2,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Humana KY Medicaid |
$2,358.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,382.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
|
PROTEGE EVERFLEX STENT 8*60*80
|
Facility
|
IP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
|
PROTEGE EVERFLEX STENT 8*80*12
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*80*12
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PROTEGE EVERFLEX STENT 8*80*80
|
Facility
|
IP
|
$6,858.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.64 |
| Max. Negotiated Rate |
$6,584.45 |
| Rate for Payer: Aetna Commercial |
$5,281.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,349.86
|
| Rate for Payer: Cash Price |
$3,429.40
|
| Rate for Payer: Cigna Commercial |
$5,692.80
|
| Rate for Payer: First Health Commercial |
$6,515.86
|
| Rate for Payer: Humana Commercial |
$5,829.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,035.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,126.23
|
| Rate for Payer: PHCS Commercial |
$6,584.45
|
| Rate for Payer: United Healthcare All Payer |
$6,035.74
|
|
