|
PROTEGE STENT 6FR 12*80*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*20*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*20*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*40*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*40*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*60*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*60*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*80*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 14*80*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 9*20*80
|
Facility
|
OP
|
$8,237.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.32 |
| Max. Negotiated Rate |
$7,908.24 |
| Rate for Payer: Aetna Commercial |
$6,343.07
|
| Rate for Payer: Anthem Medicaid |
$2,832.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,425.44
|
| Rate for Payer: Cash Price |
$4,118.88
|
| Rate for Payer: Cigna Commercial |
$6,837.33
|
| Rate for Payer: First Health Commercial |
$7,825.86
|
| Rate for Payer: Humana Commercial |
$7,002.09
|
| Rate for Payer: Humana KY Medicaid |
$2,832.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,861.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,754.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,079.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,889.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,590.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,166.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,684.05
|
| Rate for Payer: PHCS Commercial |
$7,908.24
|
| Rate for Payer: United Healthcare All Payer |
$7,249.22
|
|
|
PROTEGE STENT 6FR 9*20*80
|
Facility
|
IP
|
$8,237.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.32 |
| Max. Negotiated Rate |
$7,908.24 |
| Rate for Payer: Aetna Commercial |
$6,343.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,425.44
|
| Rate for Payer: Cash Price |
$4,118.88
|
| Rate for Payer: Cigna Commercial |
$6,837.33
|
| Rate for Payer: First Health Commercial |
$7,825.86
|
| Rate for Payer: Humana Commercial |
$7,002.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,754.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,079.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,590.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,166.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,684.05
|
| Rate for Payer: PHCS Commercial |
$7,908.24
|
| Rate for Payer: United Healthcare All Payer |
$7,249.22
|
|
|
PROTEGE STENT 6FR 9*30*80
|
Facility
|
IP
|
$8,237.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.32 |
| Max. Negotiated Rate |
$7,908.24 |
| Rate for Payer: Aetna Commercial |
$6,343.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,425.44
|
| Rate for Payer: Cash Price |
$4,118.88
|
| Rate for Payer: Cigna Commercial |
$6,837.33
|
| Rate for Payer: First Health Commercial |
$7,825.86
|
| Rate for Payer: Humana Commercial |
$7,002.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,754.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,079.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,590.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,166.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,684.05
|
| Rate for Payer: PHCS Commercial |
$7,908.24
|
| Rate for Payer: United Healthcare All Payer |
$7,249.22
|
|
|
PROTEGE STENT 6FR 9*30*80
|
Facility
|
OP
|
$8,237.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.32 |
| Max. Negotiated Rate |
$7,908.24 |
| Rate for Payer: Aetna Commercial |
$6,343.07
|
| Rate for Payer: Anthem Medicaid |
$2,832.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,425.44
|
| Rate for Payer: Cash Price |
$4,118.88
|
| Rate for Payer: Cigna Commercial |
$6,837.33
|
| Rate for Payer: First Health Commercial |
$7,825.86
|
| Rate for Payer: Humana Commercial |
$7,002.09
|
| Rate for Payer: Humana KY Medicaid |
$2,832.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,861.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,754.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,079.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,471.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,889.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,249.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,178.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,590.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,166.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,684.05
|
| Rate for Payer: PHCS Commercial |
$7,908.24
|
| Rate for Payer: United Healthcare All Payer |
$7,249.22
|
|
|
PROTEGE STENT 6FR 9*40*80
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PROTEGE STENT 6FR 9*40*80
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PROTEGE STENT 6FR 9*60*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 9*60*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 6FR 9*80*80
|
Facility
|
IP
|
$7,058.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,117.64 |
| Max. Negotiated Rate |
$6,776.45 |
| Rate for Payer: Aetna Commercial |
$5,435.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,505.86
|
| Rate for Payer: Cash Price |
$3,529.40
|
| Rate for Payer: Cigna Commercial |
$5,858.80
|
| Rate for Payer: First Health Commercial |
$6,705.86
|
| Rate for Payer: Humana Commercial |
$5,999.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,788.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,117.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,211.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,294.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,647.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,141.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,870.57
|
| Rate for Payer: PHCS Commercial |
$6,776.45
|
| Rate for Payer: United Healthcare All Payer |
$6,211.74
|
|
|
PROTEGE STENT 6FR 9*80*80
|
Facility
|
OP
|
$7,058.80
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,117.64 |
| Max. Negotiated Rate |
$6,776.45 |
| Rate for Payer: Aetna Commercial |
$5,435.28
|
| Rate for Payer: Anthem Medicaid |
$2,427.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,505.86
|
| Rate for Payer: Cash Price |
$3,529.40
|
| Rate for Payer: Cigna Commercial |
$5,858.80
|
| Rate for Payer: First Health Commercial |
$6,705.86
|
| Rate for Payer: Humana Commercial |
$5,999.98
|
| Rate for Payer: Humana KY Medicaid |
$2,427.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,452.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,788.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,117.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,476.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,211.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,294.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,647.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,141.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,870.57
|
| Rate for Payer: PHCS Commercial |
$6,776.45
|
| Rate for Payer: United Healthcare All Payer |
$6,211.74
|
|
|
PROTEGE STENT 7*15 6FR
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 7*15 6FR
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 7*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEGE STENT 7*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PROTEINSERUMTOTAL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
30000492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
PROTEINSERUMTOTAL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
30000492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
