|
STENT BIFUR 16.5CM 24M*14M
|
Facility
|
IP
|
$33,270.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.10 |
| Max. Negotiated Rate |
$31,939.20 |
| Rate for Payer: Aetna Commercial |
$25,617.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,950.60
|
| Rate for Payer: Cash Price |
$16,635.00
|
| Rate for Payer: Cigna Commercial |
$27,614.10
|
| Rate for Payer: First Health Commercial |
$31,606.50
|
| Rate for Payer: Humana Commercial |
$28,279.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,553.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,981.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,277.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,313.70
|
| Rate for Payer: PHCS Commercial |
$31,939.20
|
| Rate for Payer: United Healthcare All Payer |
$29,277.60
|
|
|
STENT BIFUR 16.5CM 24M*14M
|
Facility
|
OP
|
$33,270.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.10 |
| Max. Negotiated Rate |
$31,939.20 |
| Rate for Payer: Aetna Commercial |
$25,617.90
|
| Rate for Payer: Anthem Medicaid |
$11,441.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,950.60
|
| Rate for Payer: Cash Price |
$16,635.00
|
| Rate for Payer: Cigna Commercial |
$27,614.10
|
| Rate for Payer: First Health Commercial |
$31,606.50
|
| Rate for Payer: Humana Commercial |
$28,279.50
|
| Rate for Payer: Humana KY Medicaid |
$11,441.55
|
| Rate for Payer: Kentucky WC Medicaid |
$11,558.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,553.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,981.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,671.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,277.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,313.70
|
| Rate for Payer: PHCS Commercial |
$31,939.20
|
| Rate for Payer: United Healthcare All Payer |
$29,277.60
|
|
|
STENT BIFUR 16.5CM 26M*15M
|
Facility
|
OP
|
$35,095.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,562.35 |
| Max. Negotiated Rate |
$33,691.20 |
| Rate for Payer: Aetna Commercial |
$27,023.15
|
| Rate for Payer: Anthem Medicaid |
$12,069.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,374.10
|
| Rate for Payer: Cash Price |
$17,547.50
|
| Rate for Payer: Cigna Commercial |
$29,128.85
|
| Rate for Payer: First Health Commercial |
$33,340.25
|
| Rate for Payer: Humana Commercial |
$29,830.75
|
| Rate for Payer: Humana KY Medicaid |
$12,069.17
|
| Rate for Payer: Kentucky WC Medicaid |
$12,192.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,777.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,900.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,528.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,311.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,883.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,321.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,562.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,879.45
|
| Rate for Payer: PHCS Commercial |
$33,691.20
|
| Rate for Payer: United Healthcare All Payer |
$30,883.60
|
|
|
STENT BIFUR 16.5CM 26M*15M
|
Facility
|
IP
|
$35,095.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,562.35 |
| Max. Negotiated Rate |
$33,691.20 |
| Rate for Payer: Aetna Commercial |
$27,023.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,374.10
|
| Rate for Payer: Cash Price |
$17,547.50
|
| Rate for Payer: Cigna Commercial |
$29,128.85
|
| Rate for Payer: First Health Commercial |
$33,340.25
|
| Rate for Payer: Humana Commercial |
$29,830.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,777.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,900.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,528.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,883.60
|
| Rate for Payer: Ohio Health Group HMO |
$26,321.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,562.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,879.45
|
| Rate for Payer: PHCS Commercial |
$33,691.20
|
| Rate for Payer: United Healthcare All Payer |
$30,883.60
|
|
|
STENT BIFUR 16.5CM 28M*16M
|
Facility
|
IP
|
$33,908.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,408.14 |
| Max. Negotiated Rate |
$32,552.40 |
| Rate for Payer: Aetna Commercial |
$26,109.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,448.82
|
| Rate for Payer: Cash Price |
$16,954.38
|
| Rate for Payer: Cigna Commercial |
$28,144.26
|
| Rate for Payer: First Health Commercial |
$32,213.31
|
| Rate for Payer: Humana Commercial |
$28,822.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,805.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,024.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,839.70
|
| Rate for Payer: Ohio Health Group HMO |
$25,431.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,781.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,408.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,511.71
|
| Rate for Payer: PHCS Commercial |
$32,552.40
|
| Rate for Payer: United Healthcare All Payer |
$29,839.70
|
|
|
STENT BIFUR 16.5CM 28M*16M
|
Facility
|
OP
|
$33,908.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,408.14 |
| Max. Negotiated Rate |
$32,552.40 |
| Rate for Payer: Aetna Commercial |
$26,109.74
|
| Rate for Payer: Anthem Medicaid |
$11,661.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,448.82
|
| Rate for Payer: Cash Price |
$16,954.38
|
| Rate for Payer: Cigna Commercial |
$28,144.26
|
| Rate for Payer: First Health Commercial |
$32,213.31
|
| Rate for Payer: Humana Commercial |
$28,822.44
|
| Rate for Payer: Humana KY Medicaid |
$11,661.22
|
| Rate for Payer: Kentucky WC Medicaid |
$11,779.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,805.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,024.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,895.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,839.70
|
| Rate for Payer: Ohio Health Group HMO |
$25,431.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,781.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,408.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,511.71
|
| Rate for Payer: PHCS Commercial |
$32,552.40
|
| Rate for Payer: United Healthcare All Payer |
$29,839.70
|
|
|
STENT BILIARY 7*10 RAP EX
|
Facility
|
OP
|
$1,596.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,532.64 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Anthem Medicaid |
$549.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.27
|
| Rate for Payer: Cash Price |
$798.25
|
| Rate for Payer: Cigna Commercial |
$1,325.10
|
| Rate for Payer: First Health Commercial |
$1,516.68
|
| Rate for Payer: Humana Commercial |
$1,357.02
|
| Rate for Payer: Humana KY Medicaid |
$549.04
|
| Rate for Payer: Kentucky WC Medicaid |
$554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.92
|
| Rate for Payer: PHCS Commercial |
$1,532.64
|
| Rate for Payer: United Healthcare All Payer |
$1,404.92
|
|
|
STENT BILIARY 7*10 RAP EX
|
Facility
|
IP
|
$1,596.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,532.64 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.27
|
| Rate for Payer: Cash Price |
$798.25
|
| Rate for Payer: Cigna Commercial |
$1,325.10
|
| Rate for Payer: First Health Commercial |
$1,516.68
|
| Rate for Payer: Humana Commercial |
$1,357.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.92
|
| Rate for Payer: PHCS Commercial |
$1,532.64
|
| Rate for Payer: United Healthcare All Payer |
$1,404.92
|
|
|
STENT BILIARY 7*12 RAP EXC
|
Facility
|
OP
|
$1,596.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,532.64 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Anthem Medicaid |
$549.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.27
|
| Rate for Payer: Cash Price |
$798.25
|
| Rate for Payer: Cigna Commercial |
$1,325.10
|
| Rate for Payer: First Health Commercial |
$1,516.68
|
| Rate for Payer: Humana Commercial |
$1,357.02
|
| Rate for Payer: Humana KY Medicaid |
$549.04
|
| Rate for Payer: Kentucky WC Medicaid |
$554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.92
|
| Rate for Payer: PHCS Commercial |
$1,532.64
|
| Rate for Payer: United Healthcare All Payer |
$1,404.92
|
|
|
STENT BILIARY 7*12 RAP EXC
|
Facility
|
IP
|
$1,596.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,532.64 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.27
|
| Rate for Payer: Cash Price |
$798.25
|
| Rate for Payer: Cigna Commercial |
$1,325.10
|
| Rate for Payer: First Health Commercial |
$1,516.68
|
| Rate for Payer: Humana Commercial |
$1,357.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.92
|
| Rate for Payer: PHCS Commercial |
$1,532.64
|
| Rate for Payer: United Healthcare All Payer |
$1,404.92
|
|
|
STENT BILIARY 7*15 RAP EXC
|
Facility
|
IP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 7*15 RAP EXC
|
Facility
|
OP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem Medicaid |
$600.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Humana KY Medicaid |
$600.28
|
| Rate for Payer: Kentucky WC Medicaid |
$606.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 7*5 RAP EX
|
Facility
|
IP
|
$1,878.36
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.19 |
| Max. Negotiated Rate |
$1,803.23 |
| Rate for Payer: Aetna Commercial |
$1,446.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.12
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cigna Commercial |
$1,559.04
|
| Rate for Payer: First Health Commercial |
$1,784.44
|
| Rate for Payer: Humana Commercial |
$1,596.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.29
|
| Rate for Payer: PHCS Commercial |
$1,803.23
|
| Rate for Payer: United Healthcare All Payer |
$1,652.96
|
|
|
STENT BILIARY 7*5 RAP EX
|
Facility
|
OP
|
$1,878.36
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.19 |
| Max. Negotiated Rate |
$1,803.23 |
| Rate for Payer: Aetna Commercial |
$1,446.34
|
| Rate for Payer: Anthem Medicaid |
$645.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.12
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cigna Commercial |
$1,559.04
|
| Rate for Payer: First Health Commercial |
$1,784.44
|
| Rate for Payer: Humana Commercial |
$1,596.61
|
| Rate for Payer: Humana KY Medicaid |
$645.97
|
| Rate for Payer: Kentucky WC Medicaid |
$652.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.29
|
| Rate for Payer: PHCS Commercial |
$1,803.23
|
| Rate for Payer: United Healthcare All Payer |
$1,652.96
|
|
|
STENT BILIARY 7*7 RAP EX
|
Facility
|
IP
|
$1,878.36
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.19 |
| Max. Negotiated Rate |
$1,803.23 |
| Rate for Payer: Aetna Commercial |
$1,446.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.12
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cigna Commercial |
$1,559.04
|
| Rate for Payer: First Health Commercial |
$1,784.44
|
| Rate for Payer: Humana Commercial |
$1,596.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.29
|
| Rate for Payer: PHCS Commercial |
$1,803.23
|
| Rate for Payer: United Healthcare All Payer |
$1,652.96
|
|
|
STENT BILIARY 7*7 RAP EX
|
Facility
|
OP
|
$1,878.36
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.19 |
| Max. Negotiated Rate |
$1,803.23 |
| Rate for Payer: Aetna Commercial |
$1,446.34
|
| Rate for Payer: Anthem Medicaid |
$645.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.12
|
| Rate for Payer: Cash Price |
$939.18
|
| Rate for Payer: Cigna Commercial |
$1,559.04
|
| Rate for Payer: First Health Commercial |
$1,784.44
|
| Rate for Payer: Humana Commercial |
$1,596.61
|
| Rate for Payer: Humana KY Medicaid |
$645.97
|
| Rate for Payer: Kentucky WC Medicaid |
$652.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.29
|
| Rate for Payer: PHCS Commercial |
$1,803.23
|
| Rate for Payer: United Healthcare All Payer |
$1,652.96
|
|
|
STENT BILIARY 8.5*10 RAP EXC
|
Facility
|
OP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem Medicaid |
$600.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Humana KY Medicaid |
$600.28
|
| Rate for Payer: Kentucky WC Medicaid |
$606.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 8.5*10 RAP EXC
|
Facility
|
IP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 8.5*12 RAP EX
|
Facility
|
IP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 8.5*12 RAP EX
|
Facility
|
OP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem Medicaid |
$600.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Humana KY Medicaid |
$600.28
|
| Rate for Payer: Kentucky WC Medicaid |
$606.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 8.5*15 RAP EX
|
Facility
|
OP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem Medicaid |
$600.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Humana KY Medicaid |
$600.28
|
| Rate for Payer: Kentucky WC Medicaid |
$606.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 8.5*15 RAP EX
|
Facility
|
IP
|
$1,745.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.68 |
| Rate for Payer: Aetna Commercial |
$1,344.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.49
|
| Rate for Payer: Cash Price |
$872.75
|
| Rate for Payer: Cigna Commercial |
$1,448.76
|
| Rate for Payer: First Health Commercial |
$1,658.22
|
| Rate for Payer: Humana Commercial |
$1,483.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.10
|
| Rate for Payer: PHCS Commercial |
$1,675.68
|
| Rate for Payer: United Healthcare All Payer |
$1,536.04
|
|
|
STENT BILIARY 8.5*5 RAP EX
|
Facility
|
IP
|
$1,596.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,532.64 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.27
|
| Rate for Payer: Cash Price |
$798.25
|
| Rate for Payer: Cigna Commercial |
$1,325.10
|
| Rate for Payer: First Health Commercial |
$1,516.68
|
| Rate for Payer: Humana Commercial |
$1,357.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.92
|
| Rate for Payer: PHCS Commercial |
$1,532.64
|
| Rate for Payer: United Healthcare All Payer |
$1,404.92
|
|
|
STENT BILIARY 8.5*5 RAP EX
|
Facility
|
OP
|
$1,596.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$1,532.64 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Anthem Medicaid |
$549.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.27
|
| Rate for Payer: Cash Price |
$798.25
|
| Rate for Payer: Cigna Commercial |
$1,325.10
|
| Rate for Payer: First Health Commercial |
$1,516.68
|
| Rate for Payer: Humana Commercial |
$1,357.02
|
| Rate for Payer: Humana KY Medicaid |
$549.04
|
| Rate for Payer: Kentucky WC Medicaid |
$554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,309.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.92
|
| Rate for Payer: PHCS Commercial |
$1,532.64
|
| Rate for Payer: United Healthcare All Payer |
$1,404.92
|
|
|
STENT BILIARY 8.5*7 RAP EXC
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
