|
STENT RESONANCE METALIC 6.0*26
|
Facility
|
IP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE METALIC 6.0*26
|
Facility
|
OP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem Medicaid |
$1,952.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Humana KY Medicaid |
$1,952.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*20
|
Facility
|
IP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*20
|
Facility
|
OP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem Medicaid |
$1,952.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Humana KY Medicaid |
$1,952.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*22
|
Facility
|
IP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*22
|
Facility
|
OP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem Medicaid |
$1,952.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Humana KY Medicaid |
$1,952.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*24
|
Facility
|
OP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem Medicaid |
$1,952.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Humana KY Medicaid |
$1,952.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*24
|
Facility
|
IP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*28
|
Facility
|
OP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem Medicaid |
$1,952.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Humana KY Medicaid |
$1,952.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*28
|
Facility
|
IP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*30
|
Facility
|
OP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem Medicaid |
$1,952.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Humana KY Medicaid |
$1,952.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,972.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,991.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT RESONANCE MTALLIC 6.0*30
|
Facility
|
IP
|
$5,677.81
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$5,450.70 |
| Rate for Payer: Aetna Commercial |
$4,371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,428.69
|
| Rate for Payer: Cash Price |
$2,838.91
|
| Rate for Payer: Cigna Commercial |
$4,712.58
|
| Rate for Payer: First Health Commercial |
$5,393.92
|
| Rate for Payer: Humana Commercial |
$4,826.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,655.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,703.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,996.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,258.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,542.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,939.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.69
|
| Rate for Payer: PHCS Commercial |
$5,450.70
|
| Rate for Payer: United Healthcare All Payer |
$4,996.47
|
|
|
STENT SELF-EXP POLYFLEX 12*50
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT SELF-EXP POLYFLEX 12*50
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT SENTINOBIL 7*20*75
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
STENT SENTINOBIL 7*20*75
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
STENT SENTINOL 10*59
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 SENTINOL 10*59
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 SENTINOL 10*79
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 SENTINOL 10*79
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 SENTINOL 135CM 8*60
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 SENTINOL 135CM 8*60
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 SENTINOL 6*40*75
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
STENT SENTINOL 6*40*75
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
STENT SENTINOL 6*59
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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
|
|
