|
STENT COTTON-LEUNG BIL 11.5*7
|
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*7
|
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*9
|
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*9
|
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 7*12
|
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 7*12
|
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 7*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 7*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 7*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 7*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 7*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 7*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 7*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 7*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 DBL PIGTAIL 4.5FR*22CM
|
Facility
|
OP
|
$1,743.42
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.03 |
| Max. Negotiated Rate |
$1,673.68 |
| Rate for Payer: Aetna Commercial |
$1,342.43
|
| Rate for Payer: Anthem Medicaid |
$599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,359.87
|
| Rate for Payer: Cash Price |
$871.71
|
| Rate for Payer: Cigna Commercial |
$1,447.04
|
| Rate for Payer: First Health Commercial |
$1,656.25
|
| Rate for Payer: Humana Commercial |
$1,481.91
|
| Rate for Payer: Humana KY Medicaid |
$599.56
|
| Rate for Payer: Kentucky WC Medicaid |
$605.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,429.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,307.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.96
|
| Rate for Payer: PHCS Commercial |
$1,673.68
|
| Rate for Payer: United Healthcare All Payer |
$1,534.21
|
|
|
STENT DBL PIGTAIL 4.5FR*22CM
|
Facility
|
IP
|
$1,743.42
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.03 |
| Max. Negotiated Rate |
$1,673.68 |
| Rate for Payer: Aetna Commercial |
$1,342.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,359.87
|
| Rate for Payer: Cash Price |
$871.71
|
| Rate for Payer: Cigna Commercial |
$1,447.04
|
| Rate for Payer: First Health Commercial |
$1,656.25
|
| Rate for Payer: Humana Commercial |
$1,481.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,429.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,307.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.96
|
| Rate for Payer: PHCS Commercial |
$1,673.68
|
| Rate for Payer: United Healthcare All Payer |
$1,534.21
|
|
|
STENT DBL PIGTAIL 4.5FR*24CM
|
Facility
|
OP
|
$1,743.42
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.03 |
| Max. Negotiated Rate |
$1,673.68 |
| Rate for Payer: Aetna Commercial |
$1,342.43
|
| Rate for Payer: Anthem Medicaid |
$599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,359.87
|
| Rate for Payer: Cash Price |
$871.71
|
| Rate for Payer: Cigna Commercial |
$1,447.04
|
| Rate for Payer: First Health Commercial |
$1,656.25
|
| Rate for Payer: Humana Commercial |
$1,481.91
|
| Rate for Payer: Humana KY Medicaid |
$599.56
|
| Rate for Payer: Kentucky WC Medicaid |
$605.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,429.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,307.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.96
|
| Rate for Payer: PHCS Commercial |
$1,673.68
|
| Rate for Payer: United Healthcare All Payer |
$1,534.21
|
|
|
STENT DBL PIGTAIL 4.5FR*24CM
|
Facility
|
IP
|
$1,743.42
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.03 |
| Max. Negotiated Rate |
$1,673.68 |
| Rate for Payer: Aetna Commercial |
$1,342.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,359.87
|
| Rate for Payer: Cash Price |
$871.71
|
| Rate for Payer: Cigna Commercial |
$1,447.04
|
| Rate for Payer: First Health Commercial |
$1,656.25
|
| Rate for Payer: Humana Commercial |
$1,481.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,429.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,307.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.96
|
| Rate for Payer: PHCS Commercial |
$1,673.68
|
| Rate for Payer: United Healthcare All Payer |
$1,534.21
|
|
|
STENT DBL PIGTAIL 4.5FR*26CM
|
Facility
|
IP
|
$1,743.42
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.03 |
| Max. Negotiated Rate |
$1,673.68 |
| Rate for Payer: Aetna Commercial |
$1,342.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,359.87
|
| Rate for Payer: Cash Price |
$871.71
|
| Rate for Payer: Cigna Commercial |
$1,447.04
|
| Rate for Payer: First Health Commercial |
$1,656.25
|
| Rate for Payer: Humana Commercial |
$1,481.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,429.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,307.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.96
|
| Rate for Payer: PHCS Commercial |
$1,673.68
|
| Rate for Payer: United Healthcare All Payer |
$1,534.21
|
|
|
STENT DBL PIGTAIL 4.5FR*26CM
|
Facility
|
OP
|
$1,743.42
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.03 |
| Max. Negotiated Rate |
$1,673.68 |
| Rate for Payer: Aetna Commercial |
$1,342.43
|
| Rate for Payer: Anthem Medicaid |
$599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,359.87
|
| Rate for Payer: Cash Price |
$871.71
|
| Rate for Payer: Cigna Commercial |
$1,447.04
|
| Rate for Payer: First Health Commercial |
$1,656.25
|
| Rate for Payer: Humana Commercial |
$1,481.91
|
| Rate for Payer: Humana KY Medicaid |
$599.56
|
| Rate for Payer: Kentucky WC Medicaid |
$605.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,429.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,307.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.96
|
| Rate for Payer: PHCS Commercial |
$1,673.68
|
| Rate for Payer: United Healthcare All Payer |
$1,534.21
|
|
|
STENT DBL PIGTAIL 4.5FR*28CM
|
Facility
|
IP
|
$1,756.72
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$1,686.45 |
| Rate for Payer: Aetna Commercial |
$1,352.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,370.24
|
| Rate for Payer: Cash Price |
$878.36
|
| Rate for Payer: Cigna Commercial |
$1,458.08
|
| Rate for Payer: First Health Commercial |
$1,668.88
|
| Rate for Payer: Humana Commercial |
$1,493.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,440.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,296.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.14
|
| Rate for Payer: PHCS Commercial |
$1,686.45
|
| Rate for Payer: United Healthcare All Payer |
$1,545.91
|
|
|
STENT DBL PIGTAIL 4.5FR*28CM
|
Facility
|
OP
|
$1,756.72
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$1,686.45 |
| Rate for Payer: Aetna Commercial |
$1,352.67
|
| Rate for Payer: Anthem Medicaid |
$604.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,370.24
|
| Rate for Payer: Cash Price |
$878.36
|
| Rate for Payer: Cigna Commercial |
$1,458.08
|
| Rate for Payer: First Health Commercial |
$1,668.88
|
| Rate for Payer: Humana Commercial |
$1,493.21
|
| Rate for Payer: Humana KY Medicaid |
$604.14
|
| Rate for Payer: Kentucky WC Medicaid |
$610.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,440.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,296.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.14
|
| Rate for Payer: PHCS Commercial |
$1,686.45
|
| Rate for Payer: United Healthcare All Payer |
$1,545.91
|
|
|
STENT DBL PIGTAIL 6.0*30CM
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
STENT DBL PIGTAIL 6.0*30CM
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
STENT DBL PIGTAIL 6FR*26CM
|
Facility
|
IP
|
$1,756.72
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$1,686.45 |
| Rate for Payer: Aetna Commercial |
$1,352.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,370.24
|
| Rate for Payer: Cash Price |
$878.36
|
| Rate for Payer: Cigna Commercial |
$1,458.08
|
| Rate for Payer: First Health Commercial |
$1,668.88
|
| Rate for Payer: Humana Commercial |
$1,493.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,440.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,296.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.14
|
| Rate for Payer: PHCS Commercial |
$1,686.45
|
| Rate for Payer: United Healthcare All Payer |
$1,545.91
|
|
