|
STENT BILIARY 8.5*7 RAP EXC
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
STENT BRONCHIAL COV 10MM*4CM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
STENT BRONCHIAL COV 10MM*4CM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
STENT BRONCHIAL DUMON 10*30
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 10*30
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 10*40
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 10*40
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 12*30
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 12*30
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 12*40
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT BRONCHIAL DUMON 12*40
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT COLONIC WALLFLEX 22*90
|
Facility
|
OP
|
$12,530.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.90 |
| Max. Negotiated Rate |
$12,028.81 |
| Rate for Payer: Aetna Commercial |
$9,648.11
|
| Rate for Payer: Anthem Medicaid |
$4,309.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,773.41
|
| Rate for Payer: Cash Price |
$6,265.01
|
| Rate for Payer: Cigna Commercial |
$10,399.91
|
| Rate for Payer: First Health Commercial |
$11,903.51
|
| Rate for Payer: Humana Commercial |
$10,650.51
|
| Rate for Payer: Humana KY Medicaid |
$4,309.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,274.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,247.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,759.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,026.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,397.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,884.30
|
| Rate for Payer: PHCS Commercial |
$12,028.81
|
| Rate for Payer: United Healthcare All Payer |
$11,026.41
|
|
|
STENT COLONIC WALLFLEX 22*90
|
Facility
|
IP
|
$12,530.01
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.90 |
| Max. Negotiated Rate |
$12,028.81 |
| Rate for Payer: Aetna Commercial |
$9,648.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,773.41
|
| Rate for Payer: Cash Price |
$6,265.01
|
| Rate for Payer: Cigna Commercial |
$10,399.91
|
| Rate for Payer: First Health Commercial |
$11,903.51
|
| Rate for Payer: Humana Commercial |
$10,650.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,274.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,247.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,759.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,026.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,397.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,884.30
|
| Rate for Payer: PHCS Commercial |
$12,028.81
|
| Rate for Payer: United Healthcare All Payer |
$11,026.41
|
|
|
STENT CONTOUR 8*22CM
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
STENT CONTOUR 8*22CM
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
STENT CONTOUR 8*24CM
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
STENT CONTOUR 8*24CM
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
STENT CONTOUR VL 6*22-30
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
STENT CONTOUR VL 6*22-30
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
STENT CONTOUR VL 7*22-30
|
Facility
|
IP
|
$1,793.52
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.16 |
| Max. Negotiated Rate |
$1,721.78 |
| Rate for Payer: Aetna Commercial |
$1,381.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.95
|
| Rate for Payer: Cash Price |
$896.76
|
| Rate for Payer: Cigna Commercial |
$1,488.62
|
| Rate for Payer: First Health Commercial |
$1,703.84
|
| Rate for Payer: Humana Commercial |
$1,524.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,470.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.99
|
| Rate for Payer: PHCS Commercial |
$1,721.78
|
| Rate for Payer: United Healthcare All Payer |
$1,578.30
|
|
|
STENT CONTOUR VL 7*22-30
|
Facility
|
OP
|
$1,793.52
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.16 |
| Max. Negotiated Rate |
$1,721.78 |
| Rate for Payer: Aetna Commercial |
$1,381.01
|
| Rate for Payer: Anthem Medicaid |
$616.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.95
|
| Rate for Payer: Cash Price |
$896.76
|
| Rate for Payer: Cigna Commercial |
$1,488.62
|
| Rate for Payer: First Health Commercial |
$1,703.84
|
| Rate for Payer: Humana Commercial |
$1,524.49
|
| Rate for Payer: Humana KY Medicaid |
$616.79
|
| Rate for Payer: Kentucky WC Medicaid |
$623.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,470.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.99
|
| Rate for Payer: PHCS Commercial |
$1,721.78
|
| Rate for Payer: United Healthcare All Payer |
$1,578.30
|
|
|
STENT COTTON-LEUNG BIL 10*12
|
Facility
|
IP
|
$1,713.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$1,644.90 |
| Rate for Payer: Aetna Commercial |
$1,319.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.48
|
| Rate for Payer: Cash Price |
$856.72
|
| Rate for Payer: Cigna Commercial |
$1,422.16
|
| Rate for Payer: First Health Commercial |
$1,627.77
|
| Rate for Payer: Humana Commercial |
$1,456.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.17
|
| Rate for Payer: PHCS Commercial |
$1,644.90
|
| Rate for Payer: United Healthcare All Payer |
$1,507.83
|
|
|
STENT COTTON-LEUNG BIL 10*12
|
Facility
|
OP
|
$1,713.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$1,644.90 |
| Rate for Payer: Aetna Commercial |
$1,319.35
|
| Rate for Payer: Anthem Medicaid |
$589.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.48
|
| Rate for Payer: Cash Price |
$856.72
|
| Rate for Payer: Cigna Commercial |
$1,422.16
|
| Rate for Payer: First Health Commercial |
$1,627.77
|
| Rate for Payer: Humana Commercial |
$1,456.42
|
| Rate for Payer: Humana KY Medicaid |
$589.25
|
| Rate for Payer: Kentucky WC Medicaid |
$595.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$601.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.17
|
| Rate for Payer: PHCS Commercial |
$1,644.90
|
| Rate for Payer: United Healthcare All Payer |
$1,507.83
|
|
|
STENT COTTON-LEUNG BIL 10*15
|
Facility
|
OP
|
$1,713.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$1,644.90 |
| Rate for Payer: Aetna Commercial |
$1,319.35
|
| Rate for Payer: Anthem Medicaid |
$589.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.48
|
| Rate for Payer: Cash Price |
$856.72
|
| Rate for Payer: Cigna Commercial |
$1,422.16
|
| Rate for Payer: First Health Commercial |
$1,627.77
|
| Rate for Payer: Humana Commercial |
$1,456.42
|
| Rate for Payer: Humana KY Medicaid |
$589.25
|
| Rate for Payer: Kentucky WC Medicaid |
$595.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$601.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.17
|
| Rate for Payer: PHCS Commercial |
$1,644.90
|
| Rate for Payer: United Healthcare All Payer |
$1,507.83
|
|
|
STENT COTTON-LEUNG BIL 10*15
|
Facility
|
IP
|
$1,713.44
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$1,644.90 |
| Rate for Payer: Aetna Commercial |
$1,319.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.48
|
| Rate for Payer: Cash Price |
$856.72
|
| Rate for Payer: Cigna Commercial |
$1,422.16
|
| Rate for Payer: First Health Commercial |
$1,627.77
|
| Rate for Payer: Humana Commercial |
$1,456.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.17
|
| Rate for Payer: PHCS Commercial |
$1,644.90
|
| Rate for Payer: United Healthcare All Payer |
$1,507.83
|
|
