|
STENT COTTON-LEUNG BIL 7*9
|
Facility
|
IP
|
$1,766.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.64 |
| Max. Negotiated Rate |
$1,695.84 |
| Rate for Payer: Aetna Commercial |
$1,360.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.87
|
| Rate for Payer: Cash Price |
$883.25
|
| Rate for Payer: Cigna Commercial |
$1,466.20
|
| Rate for Payer: First Health Commercial |
$1,678.18
|
| Rate for Payer: Humana Commercial |
$1,501.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.62
|
| Rate for Payer: PHCS Commercial |
$1,695.84
|
| Rate for Payer: United Healthcare All Payer |
$1,554.52
|
|
|
STENT DBL PIGTAIL 4.5FR*22CM
|
Facility
|
IP
|
$1,758.41
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,688.07 |
| Rate for Payer: Aetna Commercial |
$1,353.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.56
|
| Rate for Payer: Cash Price |
$879.21
|
| Rate for Payer: Cigna Commercial |
$1,459.48
|
| Rate for Payer: First Health Commercial |
$1,670.49
|
| Rate for Payer: Humana Commercial |
$1,494.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.11
|
| Rate for Payer: PHCS Commercial |
$1,688.07
|
| Rate for Payer: United Healthcare All Payer |
$1,547.40
|
|
|
STENT DBL PIGTAIL 4.5FR*22CM
|
Facility
|
OP
|
$1,758.41
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,688.07 |
| Rate for Payer: Aetna Commercial |
$1,353.98
|
| Rate for Payer: Anthem Medicaid |
$604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.56
|
| Rate for Payer: Cash Price |
$879.21
|
| Rate for Payer: Cigna Commercial |
$1,459.48
|
| Rate for Payer: First Health Commercial |
$1,670.49
|
| Rate for Payer: Humana Commercial |
$1,494.65
|
| Rate for Payer: Humana KY Medicaid |
$604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$610.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.11
|
| Rate for Payer: PHCS Commercial |
$1,688.07
|
| Rate for Payer: United Healthcare All Payer |
$1,547.40
|
|
|
STENT DBL PIGTAIL 4.5FR*24CM
|
Facility
|
IP
|
$1,758.41
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,688.07 |
| Rate for Payer: Aetna Commercial |
$1,353.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.56
|
| Rate for Payer: Cash Price |
$879.21
|
| Rate for Payer: Cigna Commercial |
$1,459.48
|
| Rate for Payer: First Health Commercial |
$1,670.49
|
| Rate for Payer: Humana Commercial |
$1,494.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.11
|
| Rate for Payer: PHCS Commercial |
$1,688.07
|
| Rate for Payer: United Healthcare All Payer |
$1,547.40
|
|
|
STENT DBL PIGTAIL 4.5FR*24CM
|
Facility
|
OP
|
$1,758.41
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,688.07 |
| Rate for Payer: Aetna Commercial |
$1,353.98
|
| Rate for Payer: Anthem Medicaid |
$604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.56
|
| Rate for Payer: Cash Price |
$879.21
|
| Rate for Payer: Cigna Commercial |
$1,459.48
|
| Rate for Payer: First Health Commercial |
$1,670.49
|
| Rate for Payer: Humana Commercial |
$1,494.65
|
| Rate for Payer: Humana KY Medicaid |
$604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$610.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.11
|
| Rate for Payer: PHCS Commercial |
$1,688.07
|
| Rate for Payer: United Healthcare All Payer |
$1,547.40
|
|
|
STENT DBL PIGTAIL 4.5FR*26CM
|
Facility
|
IP
|
$1,758.41
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,688.07 |
| Rate for Payer: Aetna Commercial |
$1,353.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.56
|
| Rate for Payer: Cash Price |
$879.21
|
| Rate for Payer: Cigna Commercial |
$1,459.48
|
| Rate for Payer: First Health Commercial |
$1,670.49
|
| Rate for Payer: Humana Commercial |
$1,494.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.11
|
| Rate for Payer: PHCS Commercial |
$1,688.07
|
| Rate for Payer: United Healthcare All Payer |
$1,547.40
|
|
|
STENT DBL PIGTAIL 4.5FR*26CM
|
Facility
|
OP
|
$1,758.41
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$1,688.07 |
| Rate for Payer: Aetna Commercial |
$1,353.98
|
| Rate for Payer: Anthem Medicaid |
$604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.56
|
| Rate for Payer: Cash Price |
$879.21
|
| Rate for Payer: Cigna Commercial |
$1,459.48
|
| Rate for Payer: First Health Commercial |
$1,670.49
|
| Rate for Payer: Humana Commercial |
$1,494.65
|
| Rate for Payer: Humana KY Medicaid |
$604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$610.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.11
|
| Rate for Payer: PHCS Commercial |
$1,688.07
|
| Rate for Payer: United Healthcare All Payer |
$1,547.40
|
|
|
STENT DBL PIGTAIL 4.5FR*28CM
|
Facility
|
IP
|
$1,770.66
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$1,699.83 |
| Rate for Payer: Aetna Commercial |
$1,363.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.11
|
| Rate for Payer: Cash Price |
$885.33
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,682.13
|
| Rate for Payer: Humana Commercial |
$1,505.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.90
|
| Rate for Payer: PHCS Commercial |
$1,699.83
|
| Rate for Payer: United Healthcare All Payer |
$1,558.18
|
|
|
STENT DBL PIGTAIL 4.5FR*28CM
|
Facility
|
OP
|
$1,770.66
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$1,699.83 |
| Rate for Payer: Aetna Commercial |
$1,363.41
|
| Rate for Payer: Anthem Medicaid |
$608.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.11
|
| Rate for Payer: Cash Price |
$885.33
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,682.13
|
| Rate for Payer: Humana Commercial |
$1,505.06
|
| Rate for Payer: Humana KY Medicaid |
$608.93
|
| Rate for Payer: Kentucky WC Medicaid |
$615.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.90
|
| Rate for Payer: PHCS Commercial |
$1,699.83
|
| Rate for Payer: United Healthcare All Payer |
$1,558.18
|
|
|
STENT DBL PIGTAIL 6.0*30CM
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
STENT DBL PIGTAIL 6.0*30CM
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
STENT DBL PIGTAIL 6FR*26CM
|
Facility
|
IP
|
$1,770.66
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$1,699.83 |
| Rate for Payer: Aetna Commercial |
$1,363.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.11
|
| Rate for Payer: Cash Price |
$885.33
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,682.13
|
| Rate for Payer: Humana Commercial |
$1,505.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.90
|
| Rate for Payer: PHCS Commercial |
$1,699.83
|
| Rate for Payer: United Healthcare All Payer |
$1,558.18
|
|
|
STENT DBL PIGTAIL 6FR*26CM
|
Facility
|
OP
|
$1,770.66
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$1,699.83 |
| Rate for Payer: Aetna Commercial |
$1,363.41
|
| Rate for Payer: Anthem Medicaid |
$608.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.11
|
| Rate for Payer: Cash Price |
$885.33
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,682.13
|
| Rate for Payer: Humana Commercial |
$1,505.06
|
| Rate for Payer: Humana KY Medicaid |
$608.93
|
| Rate for Payer: Kentucky WC Medicaid |
$615.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.90
|
| Rate for Payer: PHCS Commercial |
$1,699.83
|
| Rate for Payer: United Healthcare All Payer |
$1,558.18
|
|
|
STENT DOUBLE J 6*20CM
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
STENT DOUBLE J 6*20CM
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
STENT DUMON STYLE Y 14*10*10
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 14*10*10
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 15*12*12
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 15*12*12
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 16*13*13
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 16*13*13
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 18*14*14
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DUMON STYLE Y 18*14*14
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
STENT DYNAMIC Y 13*10
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
STENT DYNAMIC Y 13*10
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
