|
STENT POLYFLEX 8*30 SELF EXP
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 POLYFLEX 8*30 SELF EXP
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 POLYFLEX AIRWAY 16*10MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 POLYFLEX AIRWAY 16*10MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 POLYFLX SELF EXP 14*60*9
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 POLYFLX SELF EXP 14*60*9
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 RESONANCE METALIC 6.0*26
|
Facility
|
IP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE METALIC 6.0*26
|
Facility
|
OP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem Medicaid |
$1,937.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Humana KY Medicaid |
$1,937.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*20
|
Facility
|
IP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*20
|
Facility
|
OP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem Medicaid |
$1,937.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Humana KY Medicaid |
$1,937.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*22
|
Facility
|
IP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*22
|
Facility
|
OP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem Medicaid |
$1,937.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Humana KY Medicaid |
$1,937.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*24
|
Facility
|
OP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem Medicaid |
$1,937.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Humana KY Medicaid |
$1,937.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*24
|
Facility
|
IP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*28
|
Facility
|
IP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*28
|
Facility
|
OP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem Medicaid |
$1,937.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Humana KY Medicaid |
$1,937.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*30
|
Facility
|
IP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT RESONANCE MTALLIC 6.0*30
|
Facility
|
OP
|
$5,632.62
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.24 |
| Max. Negotiated Rate |
$5,407.32 |
| Rate for Payer: Aetna Commercial |
$4,337.12
|
| Rate for Payer: Anthem Medicaid |
$1,937.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.44
|
| Rate for Payer: Cash Price |
$2,816.31
|
| Rate for Payer: Cigna Commercial |
$4,675.07
|
| Rate for Payer: First Health Commercial |
$5,350.99
|
| Rate for Payer: Humana Commercial |
$4,787.73
|
| Rate for Payer: Humana KY Medicaid |
$1,937.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,618.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,156.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,956.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,126.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.11
|
| Rate for Payer: PHCS Commercial |
$5,407.32
|
| Rate for Payer: United Healthcare All Payer |
$4,956.71
|
|
|
STENT SELF-EXP POLYFLEX 12*50
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 SELF-EXP POLYFLEX 12*50
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 SENTINOBIL 7*20*75
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
STENT SENTINOBIL 7*20*75
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
STENT SENTINOL 10*59
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
STENT SENTINOL 10*59
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
STENT SENTINOL 10*79
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
