|
STENT WALL 6MM*36MM*100CM
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
STENT WALL 6MM*36MM*100CM
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
STENT WALL 7*34*100
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
STENT WALL 7*34*100
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
STENT WALL 7MM*23MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 7MM*23MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 7MM*34MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 7MM*34MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*20MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*20MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*38MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*38MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 9MM*35MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 9MM*35MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 9MM*35MM*160CM
|
Facility
|
OP
|
$6,896.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.53 |
| Max. Negotiated Rate |
$6,620.54 |
| Rate for Payer: Aetna Commercial |
$5,310.23
|
| Rate for Payer: Anthem Medicaid |
$2,371.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,379.19
|
| Rate for Payer: Cash Price |
$3,448.20
|
| Rate for Payer: Cigna Commercial |
$5,724.01
|
| Rate for Payer: First Health Commercial |
$6,551.58
|
| Rate for Payer: Humana Commercial |
$5,861.94
|
| Rate for Payer: Humana KY Medicaid |
$2,371.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,395.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,655.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,089.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,419.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,068.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,172.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,137.88
|
| Rate for Payer: PHCS Commercial |
$6,620.54
|
| Rate for Payer: United Healthcare All Payer |
$6,068.83
|
|
|
STENT WALL 9MM*35MM*160CM
|
Facility
|
IP
|
$6,896.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.53 |
| Max. Negotiated Rate |
$6,620.54 |
| Rate for Payer: Aetna Commercial |
$5,310.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,379.19
|
| Rate for Payer: Cash Price |
$3,448.20
|
| Rate for Payer: Cigna Commercial |
$5,724.01
|
| Rate for Payer: First Health Commercial |
$6,551.58
|
| Rate for Payer: Humana Commercial |
$5,861.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,655.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,089.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,068.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,172.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,137.88
|
| Rate for Payer: PHCS Commercial |
$6,620.54
|
| Rate for Payer: United Healthcare All Payer |
$6,068.83
|
|
|
STENT WALLFLEX 22*120MM 10FR
|
Facility
|
OP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem Medicaid |
$4,392.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Humana KY Medicaid |
$4,392.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,480.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
STENT WALLFLEX 22*120MM 10FR
|
Facility
|
IP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
STENT WALLFLEX 22*90MM 10FR
|
Facility
|
IP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
STENT WALLFLEX 22*90MM 10FR
|
Facility
|
OP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem Medicaid |
$4,392.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Humana KY Medicaid |
$4,392.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,480.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
STENT WALLFLEX 25*120MM 10FR
|
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 WALLFLEX 25*120MM 10FR
|
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 WALLFLEX 25*60MM 10FR
|
Facility
|
IP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
STENT WALLFLEX 25*60MM 10FR
|
Facility
|
OP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem Medicaid |
$4,392.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Humana KY Medicaid |
$4,392.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,480.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
STENT WALLFLEX 25*90MM 10FR
|
Facility
|
IP
|
$13,035.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,694.63 |
| Max. Negotiated Rate |
$12,514.22 |
| Rate for Payer: Aetna Commercial |
$10,037.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,167.81
|
| Rate for Payer: Cash Price |
$6,517.82
|
| Rate for Payer: Cigna Commercial |
$10,819.59
|
| Rate for Payer: First Health Commercial |
$12,383.87
|
| Rate for Payer: Humana Commercial |
$11,080.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,620.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,910.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,471.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,607.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,694.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,041.05
|
| Rate for Payer: PHCS Commercial |
$12,514.22
|
| Rate for Payer: United Healthcare All Payer |
$11,471.37
|
|
