|
STENT EXPRESS LD 10MM*25MM
|
Facility
|
IP
|
$7,159.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.86 |
| Max. Negotiated Rate |
$6,873.16 |
| Rate for Payer: Aetna Commercial |
$5,512.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,584.44
|
| Rate for Payer: Cash Price |
$3,579.77
|
| Rate for Payer: Cigna Commercial |
$5,942.42
|
| Rate for Payer: First Health Commercial |
$6,801.56
|
| Rate for Payer: Humana Commercial |
$6,085.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,870.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,283.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,300.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,369.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,727.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,940.08
|
| Rate for Payer: PHCS Commercial |
$6,873.16
|
| Rate for Payer: United Healthcare All Payer |
$6,300.40
|
|
|
STENT EXPRESS LD 10MM*25MM
|
Facility
|
OP
|
$7,159.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.86 |
| Max. Negotiated Rate |
$6,873.16 |
| Rate for Payer: Aetna Commercial |
$5,512.85
|
| Rate for Payer: Anthem Medicaid |
$2,462.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,584.44
|
| Rate for Payer: Cash Price |
$3,579.77
|
| Rate for Payer: Cigna Commercial |
$5,942.42
|
| Rate for Payer: First Health Commercial |
$6,801.56
|
| Rate for Payer: Humana Commercial |
$6,085.61
|
| Rate for Payer: Humana KY Medicaid |
$2,462.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,870.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,283.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,511.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,300.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,369.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,727.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,940.08
|
| Rate for Payer: PHCS Commercial |
$6,873.16
|
| Rate for Payer: United Healthcare All Payer |
$6,300.40
|
|
|
STENT EXPRESS LD 10MM*37MM
|
Facility
|
OP
|
$7,480.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,244.22 |
| Max. Negotiated Rate |
$7,181.51 |
| Rate for Payer: Aetna Commercial |
$5,760.17
|
| Rate for Payer: Anthem Medicaid |
$2,572.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,834.98
|
| Rate for Payer: Cash Price |
$3,740.37
|
| Rate for Payer: Cigna Commercial |
$6,209.01
|
| Rate for Payer: First Health Commercial |
$7,106.70
|
| Rate for Payer: Humana Commercial |
$6,358.63
|
| Rate for Payer: Humana KY Medicaid |
$2,572.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,520.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,984.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,161.71
|
| Rate for Payer: PHCS Commercial |
$7,181.51
|
| Rate for Payer: United Healthcare All Payer |
$6,583.05
|
|
|
STENT EXPRESS LD 10MM*37MM
|
Facility
|
IP
|
$7,480.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,244.22 |
| Max. Negotiated Rate |
$7,181.51 |
| Rate for Payer: Aetna Commercial |
$5,760.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,834.98
|
| Rate for Payer: Cash Price |
$3,740.37
|
| Rate for Payer: Cigna Commercial |
$6,209.01
|
| Rate for Payer: First Health Commercial |
$7,106.70
|
| Rate for Payer: Humana Commercial |
$6,358.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,520.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,984.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,161.71
|
| Rate for Payer: PHCS Commercial |
$7,181.51
|
| Rate for Payer: United Healthcare All Payer |
$6,583.05
|
|
|
STENT EXPRESS LD 6*17*135
|
Facility
|
IP
|
$7,159.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.86 |
| Max. Negotiated Rate |
$6,873.16 |
| Rate for Payer: Aetna Commercial |
$5,512.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,584.44
|
| Rate for Payer: Cash Price |
$3,579.77
|
| Rate for Payer: Cigna Commercial |
$5,942.42
|
| Rate for Payer: First Health Commercial |
$6,801.56
|
| Rate for Payer: Humana Commercial |
$6,085.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,870.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,283.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,300.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,369.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,727.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,940.08
|
| Rate for Payer: PHCS Commercial |
$6,873.16
|
| Rate for Payer: United Healthcare All Payer |
$6,300.40
|
|
|
STENT EXPRESS LD 6*17*135
|
Facility
|
OP
|
$7,159.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.86 |
| Max. Negotiated Rate |
$6,873.16 |
| Rate for Payer: Aetna Commercial |
$5,512.85
|
| Rate for Payer: Anthem Medicaid |
$2,462.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,584.44
|
| Rate for Payer: Cash Price |
$3,579.77
|
| Rate for Payer: Cigna Commercial |
$5,942.42
|
| Rate for Payer: First Health Commercial |
$6,801.56
|
| Rate for Payer: Humana Commercial |
$6,085.61
|
| Rate for Payer: Humana KY Medicaid |
$2,462.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,870.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,283.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,511.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,300.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,369.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,727.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,940.08
|
| Rate for Payer: PHCS Commercial |
$6,873.16
|
| Rate for Payer: United Healthcare All Payer |
$6,300.40
|
|
|
STENT EXPRESS LD 6MM*17MM
|
Facility
|
IP
|
$7,254.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,176.22 |
| Max. Negotiated Rate |
$6,963.92 |
| Rate for Payer: Aetna Commercial |
$5,585.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,658.18
|
| Rate for Payer: Cash Price |
$3,627.04
|
| Rate for Payer: Cigna Commercial |
$6,020.89
|
| Rate for Payer: First Health Commercial |
$6,891.38
|
| Rate for Payer: Humana Commercial |
$6,165.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,948.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,353.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,176.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,383.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,440.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,803.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,311.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,005.32
|
| Rate for Payer: PHCS Commercial |
$6,963.92
|
| Rate for Payer: United Healthcare All Payer |
$6,383.59
|
|
|
STENT EXPRESS LD 6MM*17MM
|
Facility
|
OP
|
$7,254.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,176.22 |
| Max. Negotiated Rate |
$6,963.92 |
| Rate for Payer: Aetna Commercial |
$5,585.64
|
| Rate for Payer: Anthem Medicaid |
$2,494.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,658.18
|
| Rate for Payer: Cash Price |
$3,627.04
|
| Rate for Payer: Cigna Commercial |
$6,020.89
|
| Rate for Payer: First Health Commercial |
$6,891.38
|
| Rate for Payer: Humana Commercial |
$6,165.97
|
| Rate for Payer: Humana KY Medicaid |
$2,494.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,520.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,948.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,353.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,176.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,544.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,383.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,440.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,803.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,311.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,005.32
|
| Rate for Payer: PHCS Commercial |
$6,963.92
|
| Rate for Payer: United Healthcare All Payer |
$6,383.59
|
|
|
STENT EXPRESS LD 6MM*27MM
|
Facility
|
IP
|
$7,480.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,244.22 |
| Max. Negotiated Rate |
$7,181.51 |
| Rate for Payer: Aetna Commercial |
$5,760.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,834.98
|
| Rate for Payer: Cash Price |
$3,740.37
|
| Rate for Payer: Cigna Commercial |
$6,209.01
|
| Rate for Payer: First Health Commercial |
$7,106.70
|
| Rate for Payer: Humana Commercial |
$6,358.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,520.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,984.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,161.71
|
| Rate for Payer: PHCS Commercial |
$7,181.51
|
| Rate for Payer: United Healthcare All Payer |
$6,583.05
|
|
|
STENT EXPRESS LD 6MM*27MM
|
Facility
|
OP
|
$7,480.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,244.22 |
| Max. Negotiated Rate |
$7,181.51 |
| Rate for Payer: Aetna Commercial |
$5,760.17
|
| Rate for Payer: Anthem Medicaid |
$2,572.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,834.98
|
| Rate for Payer: Cash Price |
$3,740.37
|
| Rate for Payer: Cigna Commercial |
$6,209.01
|
| Rate for Payer: First Health Commercial |
$7,106.70
|
| Rate for Payer: Humana Commercial |
$6,358.63
|
| Rate for Payer: Humana KY Medicaid |
$2,572.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,520.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,984.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,161.71
|
| Rate for Payer: PHCS Commercial |
$7,181.51
|
| Rate for Payer: United Healthcare All Payer |
$6,583.05
|
|
|
STENT EXPRESS LD 6MM*37MM
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
STENT EXPRESS LD 6MM*37MM
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
STENT EXPRESS LD 6MM*57MM
|
Facility
|
IP
|
$7,801.94
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.58 |
| Max. Negotiated Rate |
$7,489.86 |
| Rate for Payer: Aetna Commercial |
$6,007.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,085.51
|
| Rate for Payer: Cash Price |
$3,900.97
|
| Rate for Payer: Cigna Commercial |
$6,475.61
|
| Rate for Payer: First Health Commercial |
$7,411.84
|
| Rate for Payer: Humana Commercial |
$6,631.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,397.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,757.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,865.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,851.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,241.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,787.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,383.34
|
| Rate for Payer: PHCS Commercial |
$7,489.86
|
| Rate for Payer: United Healthcare All Payer |
$6,865.71
|
|
|
STENT EXPRESS LD 6MM*57MM
|
Facility
|
OP
|
$7,801.94
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.58 |
| Max. Negotiated Rate |
$7,489.86 |
| Rate for Payer: Aetna Commercial |
$6,007.49
|
| Rate for Payer: Anthem Medicaid |
$2,683.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,085.51
|
| Rate for Payer: Cash Price |
$3,900.97
|
| Rate for Payer: Cigna Commercial |
$6,475.61
|
| Rate for Payer: First Health Commercial |
$7,411.84
|
| Rate for Payer: Humana Commercial |
$6,631.65
|
| Rate for Payer: Humana KY Medicaid |
$2,683.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,710.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,397.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,757.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,736.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,865.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,851.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,241.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,787.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,383.34
|
| Rate for Payer: PHCS Commercial |
$7,489.86
|
| Rate for Payer: United Healthcare All Payer |
$6,865.71
|
|
|
STENT EXPRESS LD 7*17*135
|
Facility
|
IP
|
$7,159.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.86 |
| Max. Negotiated Rate |
$6,873.16 |
| Rate for Payer: Aetna Commercial |
$5,512.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,584.44
|
| Rate for Payer: Cash Price |
$3,579.77
|
| Rate for Payer: Cigna Commercial |
$5,942.42
|
| Rate for Payer: First Health Commercial |
$6,801.56
|
| Rate for Payer: Humana Commercial |
$6,085.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,870.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,283.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,300.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,369.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,727.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,940.08
|
| Rate for Payer: PHCS Commercial |
$6,873.16
|
| Rate for Payer: United Healthcare All Payer |
$6,300.40
|
|
|
STENT EXPRESS LD 7*17*135
|
Facility
|
OP
|
$7,159.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.86 |
| Max. Negotiated Rate |
$6,873.16 |
| Rate for Payer: Aetna Commercial |
$5,512.85
|
| Rate for Payer: Anthem Medicaid |
$2,462.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,584.44
|
| Rate for Payer: Cash Price |
$3,579.77
|
| Rate for Payer: Cigna Commercial |
$5,942.42
|
| Rate for Payer: First Health Commercial |
$6,801.56
|
| Rate for Payer: Humana Commercial |
$6,085.61
|
| Rate for Payer: Humana KY Medicaid |
$2,462.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,870.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,283.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,147.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,511.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,300.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,369.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,727.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,940.08
|
| Rate for Payer: PHCS Commercial |
$6,873.16
|
| Rate for Payer: United Healthcare All Payer |
$6,300.40
|
|
|
STENT EXPRESS LD 7MM*37MM
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
STENT EXPRESS LD 7MM*37MM
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
STENT EXPRESS LD 8MM*17MM
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
STENT EXPRESS LD 8MM*17MM
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
STENT EXPRESS LD 8MM*57MM*75
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
STENT EXPRESS LD 8MM*57MM*75
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
STENT EXPRESS LD 9MM*25MM*75
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
STENT EXPRESS LD 9MM*25MM*75
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
STENT G FLEX PIGTAIL 10F*5CM
|
Facility
|
IP
|
$1,714.20
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$514.26 |
| Max. Negotiated Rate |
$1,645.63 |
| Rate for Payer: Aetna Commercial |
$1,319.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,337.08
|
| Rate for Payer: Cash Price |
$857.10
|
| Rate for Payer: Cigna Commercial |
$1,422.79
|
| Rate for Payer: First Health Commercial |
$1,628.49
|
| Rate for Payer: Humana Commercial |
$1,457.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,265.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,508.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.80
|
| Rate for Payer: PHCS Commercial |
$1,645.63
|
| Rate for Payer: United Healthcare All Payer |
$1,508.50
|
|
