|
STENT COLONIC WALLFLEX 22*90
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
STENT CONTOUR 8*22CM
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
STENT CONTOUR 8*22CM
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
STENT CONTOUR 8*24CM
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
STENT CONTOUR 8*24CM
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
STENT CONTOUR VL 6*22-30
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
STENT CONTOUR VL 6*22-30
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
STENT CONTOUR VL 7*22-30
|
Facility
|
IP
|
$1,781.54
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$534.46 |
| Max. Negotiated Rate |
$1,710.28 |
| Rate for Payer: Aetna Commercial |
$1,371.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,389.60
|
| Rate for Payer: Cash Price |
$890.77
|
| Rate for Payer: Cigna Commercial |
$1,478.68
|
| Rate for Payer: First Health Commercial |
$1,692.46
|
| Rate for Payer: Humana Commercial |
$1,514.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,460.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,314.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,567.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,549.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.26
|
| Rate for Payer: PHCS Commercial |
$1,710.28
|
| Rate for Payer: United Healthcare All Payer |
$1,567.76
|
|
|
STENT CONTOUR VL 7*22-30
|
Facility
|
OP
|
$1,781.54
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$534.46 |
| Max. Negotiated Rate |
$1,710.28 |
| Rate for Payer: Aetna Commercial |
$1,371.79
|
| Rate for Payer: Anthem Medicaid |
$612.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,389.60
|
| Rate for Payer: Cash Price |
$890.77
|
| Rate for Payer: Cigna Commercial |
$1,478.68
|
| Rate for Payer: First Health Commercial |
$1,692.46
|
| Rate for Payer: Humana Commercial |
$1,514.31
|
| Rate for Payer: Humana KY Medicaid |
$612.67
|
| Rate for Payer: Kentucky WC Medicaid |
$618.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,460.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,314.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$624.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,567.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,549.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.26
|
| Rate for Payer: PHCS Commercial |
$1,710.28
|
| Rate for Payer: United Healthcare All Payer |
$1,567.76
|
|
|
STENT COTTON-LEUNG BIL 10*12
|
Facility
|
OP
|
$1,694.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.38 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,304.83
|
| Rate for Payer: Anthem Medicaid |
$582.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.78
|
| Rate for Payer: Cash Price |
$847.30
|
| Rate for Payer: Cigna Commercial |
$1,406.51
|
| Rate for Payer: First Health Commercial |
$1,609.86
|
| Rate for Payer: Humana Commercial |
$1,440.40
|
| Rate for Payer: Humana KY Medicaid |
$582.77
|
| Rate for Payer: Kentucky WC Medicaid |
$588.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,355.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.27
|
| Rate for Payer: PHCS Commercial |
$1,626.81
|
| Rate for Payer: United Healthcare All Payer |
$1,491.24
|
|
|
STENT COTTON-LEUNG BIL 10*12
|
Facility
|
IP
|
$1,694.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.38 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,304.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.78
|
| Rate for Payer: Cash Price |
$847.30
|
| Rate for Payer: Cigna Commercial |
$1,406.51
|
| Rate for Payer: First Health Commercial |
$1,609.86
|
| Rate for Payer: Humana Commercial |
$1,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,355.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.27
|
| Rate for Payer: PHCS Commercial |
$1,626.81
|
| Rate for Payer: United Healthcare All Payer |
$1,491.24
|
|
|
STENT COTTON-LEUNG BIL 10*15
|
Facility
|
IP
|
$1,694.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.38 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,304.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.78
|
| Rate for Payer: Cash Price |
$847.30
|
| Rate for Payer: Cigna Commercial |
$1,406.51
|
| Rate for Payer: First Health Commercial |
$1,609.86
|
| Rate for Payer: Humana Commercial |
$1,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,355.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.27
|
| Rate for Payer: PHCS Commercial |
$1,626.81
|
| Rate for Payer: United Healthcare All Payer |
$1,491.24
|
|
|
STENT COTTON-LEUNG BIL 10*15
|
Facility
|
OP
|
$1,694.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.38 |
| Max. Negotiated Rate |
$1,626.81 |
| Rate for Payer: Aetna Commercial |
$1,304.83
|
| Rate for Payer: Anthem Medicaid |
$582.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.78
|
| Rate for Payer: Cash Price |
$847.30
|
| Rate for Payer: Cigna Commercial |
$1,406.51
|
| Rate for Payer: First Health Commercial |
$1,609.86
|
| Rate for Payer: Humana Commercial |
$1,440.40
|
| Rate for Payer: Humana KY Medicaid |
$582.77
|
| Rate for Payer: Kentucky WC Medicaid |
$588.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,355.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.27
|
| Rate for Payer: PHCS Commercial |
$1,626.81
|
| Rate for Payer: United Healthcare All Payer |
$1,491.24
|
|
|
STENT COTTON-LEUNG BIL 10*5
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT COTTON-LEUNG BIL 10*5
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT COTTON-LEUNG BIL 10*7
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT COTTON-LEUNG BIL 10*7
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT COTTON-LEUNG BIL 10*9
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT COTTON-LEUNG BIL 10*9
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT COTTON-LEUNG BIL 11.5*12
|
Facility
|
OP
|
$1,734.95
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$1,665.55 |
| Rate for Payer: Aetna Commercial |
$1,335.91
|
| Rate for Payer: Anthem Medicaid |
$596.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.26
|
| Rate for Payer: Cash Price |
$867.47
|
| Rate for Payer: Cigna Commercial |
$1,440.01
|
| Rate for Payer: First Health Commercial |
$1,648.20
|
| Rate for Payer: Humana Commercial |
$1,474.71
|
| Rate for Payer: Humana KY Medicaid |
$596.65
|
| Rate for Payer: Kentucky WC Medicaid |
$602.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.12
|
| Rate for Payer: PHCS Commercial |
$1,665.55
|
| Rate for Payer: United Healthcare All Payer |
$1,526.76
|
|
|
STENT COTTON-LEUNG BIL 11.5*12
|
Facility
|
IP
|
$1,734.95
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$1,665.55 |
| Rate for Payer: Aetna Commercial |
$1,335.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.26
|
| Rate for Payer: Cash Price |
$867.47
|
| Rate for Payer: Cigna Commercial |
$1,440.01
|
| Rate for Payer: First Health Commercial |
$1,648.20
|
| Rate for Payer: Humana Commercial |
$1,474.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.12
|
| Rate for Payer: PHCS Commercial |
$1,665.55
|
| Rate for Payer: United Healthcare All Payer |
$1,526.76
|
|
|
STENT COTTON-LEUNG BIL 11.5*15
|
Facility
|
OP
|
$1,734.95
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$1,665.55 |
| Rate for Payer: Aetna Commercial |
$1,335.91
|
| Rate for Payer: Anthem Medicaid |
$596.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.26
|
| Rate for Payer: Cash Price |
$867.47
|
| Rate for Payer: Cigna Commercial |
$1,440.01
|
| Rate for Payer: First Health Commercial |
$1,648.20
|
| Rate for Payer: Humana Commercial |
$1,474.71
|
| Rate for Payer: Humana KY Medicaid |
$596.65
|
| Rate for Payer: Kentucky WC Medicaid |
$602.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.12
|
| Rate for Payer: PHCS Commercial |
$1,665.55
|
| Rate for Payer: United Healthcare All Payer |
$1,526.76
|
|
|
STENT COTTON-LEUNG BIL 11.5*15
|
Facility
|
IP
|
$1,734.95
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$1,665.55 |
| Rate for Payer: Aetna Commercial |
$1,335.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.26
|
| Rate for Payer: Cash Price |
$867.47
|
| Rate for Payer: Cigna Commercial |
$1,440.01
|
| Rate for Payer: First Health Commercial |
$1,648.20
|
| Rate for Payer: Humana Commercial |
$1,474.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.12
|
| Rate for Payer: PHCS Commercial |
$1,665.55
|
| Rate for Payer: United Healthcare All Payer |
$1,526.76
|
|
|
STENT COTTON-LEUNG BIL 11.5*5
|
Facility
|
OP
|
$1,734.95
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$1,665.55 |
| Rate for Payer: Aetna Commercial |
$1,335.91
|
| Rate for Payer: Anthem Medicaid |
$596.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.26
|
| Rate for Payer: Cash Price |
$867.47
|
| Rate for Payer: Cigna Commercial |
$1,440.01
|
| Rate for Payer: First Health Commercial |
$1,648.20
|
| Rate for Payer: Humana Commercial |
$1,474.71
|
| Rate for Payer: Humana KY Medicaid |
$596.65
|
| Rate for Payer: Kentucky WC Medicaid |
$602.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.12
|
| Rate for Payer: PHCS Commercial |
$1,665.55
|
| Rate for Payer: United Healthcare All Payer |
$1,526.76
|
|
|
STENT COTTON-LEUNG BIL 11.5*5
|
Facility
|
IP
|
$1,734.95
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.49 |
| Max. Negotiated Rate |
$1,665.55 |
| Rate for Payer: Aetna Commercial |
$1,335.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.26
|
| Rate for Payer: Cash Price |
$867.47
|
| Rate for Payer: Cigna Commercial |
$1,440.01
|
| Rate for Payer: First Health Commercial |
$1,648.20
|
| Rate for Payer: Humana Commercial |
$1,474.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.12
|
| Rate for Payer: PHCS Commercial |
$1,665.55
|
| Rate for Payer: United Healthcare All Payer |
$1,526.76
|
|
