|
STENT BILIARY 7*5 RAP EX
|
Facility
|
IP
|
$1,705.42
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.63 |
| Max. Negotiated Rate |
$1,637.20 |
| Rate for Payer: Aetna Commercial |
$1,313.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.23
|
| Rate for Payer: Cash Price |
$852.71
|
| Rate for Payer: Cigna Commercial |
$1,415.50
|
| Rate for Payer: First Health Commercial |
$1,620.15
|
| Rate for Payer: Humana Commercial |
$1,449.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.74
|
| Rate for Payer: PHCS Commercial |
$1,637.20
|
| Rate for Payer: United Healthcare All Payer |
$1,500.77
|
|
|
STENT BILIARY 7*5 RAP EX
|
Facility
|
OP
|
$1,705.42
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.63 |
| Max. Negotiated Rate |
$1,637.20 |
| Rate for Payer: Aetna Commercial |
$1,313.17
|
| Rate for Payer: Anthem Medicaid |
$586.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.23
|
| Rate for Payer: Cash Price |
$852.71
|
| Rate for Payer: Cigna Commercial |
$1,415.50
|
| Rate for Payer: First Health Commercial |
$1,620.15
|
| Rate for Payer: Humana Commercial |
$1,449.61
|
| Rate for Payer: Humana KY Medicaid |
$586.49
|
| Rate for Payer: Kentucky WC Medicaid |
$592.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.74
|
| Rate for Payer: PHCS Commercial |
$1,637.20
|
| Rate for Payer: United Healthcare All Payer |
$1,500.77
|
|
|
STENT BILIARY 7*7 RAP EX
|
Facility
|
IP
|
$1,873.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.10 |
| Max. Negotiated Rate |
$1,798.70 |
| Rate for Payer: Aetna Commercial |
$1,442.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.45
|
| Rate for Payer: Cash Price |
$936.82
|
| Rate for Payer: Cigna Commercial |
$1,555.13
|
| Rate for Payer: First Health Commercial |
$1,779.97
|
| Rate for Payer: Humana Commercial |
$1,592.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.82
|
| Rate for Payer: PHCS Commercial |
$1,798.70
|
| Rate for Payer: United Healthcare All Payer |
$1,648.81
|
|
|
STENT BILIARY 7*7 RAP EX
|
Facility
|
OP
|
$1,873.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.10 |
| Max. Negotiated Rate |
$1,798.70 |
| Rate for Payer: Aetna Commercial |
$1,442.71
|
| Rate for Payer: Anthem Medicaid |
$644.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.45
|
| Rate for Payer: Cash Price |
$936.82
|
| Rate for Payer: Cigna Commercial |
$1,555.13
|
| Rate for Payer: First Health Commercial |
$1,779.97
|
| Rate for Payer: Humana Commercial |
$1,592.60
|
| Rate for Payer: Humana KY Medicaid |
$644.35
|
| Rate for Payer: Kentucky WC Medicaid |
$650.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.82
|
| Rate for Payer: PHCS Commercial |
$1,798.70
|
| Rate for Payer: United Healthcare All Payer |
$1,648.81
|
|
|
STENT BILIARY 8.5*10 RAP EXC
|
Facility
|
IP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 8.5*10 RAP EXC
|
Facility
|
OP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem Medicaid |
$594.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Humana KY Medicaid |
$594.74
|
| Rate for Payer: Kentucky WC Medicaid |
$600.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 8.5*12 RAP EX
|
Facility
|
OP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem Medicaid |
$594.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Humana KY Medicaid |
$594.74
|
| Rate for Payer: Kentucky WC Medicaid |
$600.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 8.5*12 RAP EX
|
Facility
|
IP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 8.5*15 RAP EX
|
Facility
|
OP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem Medicaid |
$594.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Humana KY Medicaid |
$594.74
|
| Rate for Payer: Kentucky WC Medicaid |
$600.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 8.5*15 RAP EX
|
Facility
|
IP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 8.5*5 RAP EX
|
Facility
|
IP
|
$1,576.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$1,513.15 |
| Rate for Payer: Aetna Commercial |
$1,213.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.44
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$1,308.25
|
| Rate for Payer: First Health Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial |
$1,339.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.58
|
| Rate for Payer: PHCS Commercial |
$1,513.15
|
| Rate for Payer: United Healthcare All Payer |
$1,387.06
|
|
|
STENT BILIARY 8.5*5 RAP EX
|
Facility
|
OP
|
$1,576.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$1,513.15 |
| Rate for Payer: Aetna Commercial |
$1,213.67
|
| Rate for Payer: Anthem Medicaid |
$542.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.44
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$1,308.25
|
| Rate for Payer: First Health Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial |
$1,339.77
|
| Rate for Payer: Humana KY Medicaid |
$542.06
|
| Rate for Payer: Kentucky WC Medicaid |
$547.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.58
|
| Rate for Payer: PHCS Commercial |
$1,513.15
|
| Rate for Payer: United Healthcare All Payer |
$1,387.06
|
|
|
STENT BILIARY 8.5*7 RAP EXC
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
STENT BILIARY 8.5*7 RAP EXC
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
STENT BRONCHIAL COV 10MM*4CM
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT BRONCHIAL COV 10MM*4CM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT BRONCHIAL DUMON 10*30
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 10*30
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 10*40
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 10*40
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 12*30
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 12*30
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 12*40
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT BRONCHIAL DUMON 12*40
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT COLONIC WALLFLEX 22*90
|
Facility
|
OP
|
$12,780.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,834.18 |
| Max. Negotiated Rate |
$12,269.37 |
| Rate for Payer: Aetna Commercial |
$9,841.05
|
| Rate for Payer: Anthem Medicaid |
$4,395.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,968.86
|
| Rate for Payer: Cash Price |
$6,390.29
|
| Rate for Payer: Cigna Commercial |
$10,607.89
|
| Rate for Payer: First Health Commercial |
$12,141.56
|
| Rate for Payer: Humana Commercial |
$10,863.50
|
| Rate for Payer: Humana KY Medicaid |
$4,395.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,439.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,432.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,834.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,483.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,585.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,224.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,119.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,818.61
|
| Rate for Payer: PHCS Commercial |
$12,269.37
|
| Rate for Payer: United Healthcare All Payer |
$11,246.92
|
|
