|
STENT WALL 7*34*100
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
STENT WALL 7*34*100
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
STENT WALL 7MM*23MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 7MM*23MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 7MM*34MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 7MM*34MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*20MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*20MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*38MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 8MM*38MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 9MM*35MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 9MM*35MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT WALL 9MM*35MM*160CM
|
Facility
|
IP
|
$7,096.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.92 |
| Max. Negotiated Rate |
$6,812.54 |
| Rate for Payer: Aetna Commercial |
$5,464.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.19
|
| Rate for Payer: Cash Price |
$3,548.20
|
| Rate for Payer: Cigna Commercial |
$5,890.01
|
| Rate for Payer: First Health Commercial |
$6,741.58
|
| Rate for Payer: Humana Commercial |
$6,031.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,244.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,677.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,173.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.52
|
| Rate for Payer: PHCS Commercial |
$6,812.54
|
| Rate for Payer: United Healthcare All Payer |
$6,244.83
|
|
|
STENT WALL 9MM*35MM*160CM
|
Facility
|
OP
|
$7,096.40
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.92 |
| Max. Negotiated Rate |
$6,812.54 |
| Rate for Payer: Aetna Commercial |
$5,464.23
|
| Rate for Payer: Anthem Medicaid |
$2,440.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.19
|
| Rate for Payer: Cash Price |
$3,548.20
|
| Rate for Payer: Cigna Commercial |
$5,890.01
|
| Rate for Payer: First Health Commercial |
$6,741.58
|
| Rate for Payer: Humana Commercial |
$6,031.94
|
| Rate for Payer: Humana KY Medicaid |
$2,440.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,465.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,244.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,677.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,173.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.52
|
| Rate for Payer: PHCS Commercial |
$6,812.54
|
| Rate for Payer: United Healthcare All Payer |
$6,244.83
|
|
|
STENT WALLFLEX 22*120MM 10FR
|
Facility
|
IP
|
$13,023.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.09 |
| Max. Negotiated Rate |
$12,502.70 |
| Rate for Payer: Aetna Commercial |
$10,028.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,158.45
|
| Rate for Payer: Cash Price |
$6,511.82
|
| Rate for Payer: Cigna Commercial |
$10,809.63
|
| Rate for Payer: First Health Commercial |
$12,372.47
|
| Rate for Payer: Humana Commercial |
$11,070.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,679.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,611.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,907.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,986.32
|
| Rate for Payer: PHCS Commercial |
$12,502.70
|
| Rate for Payer: United Healthcare All Payer |
$11,460.81
|
|
|
STENT WALLFLEX 22*120MM 10FR
|
Facility
|
OP
|
$13,023.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.09 |
| Max. Negotiated Rate |
$12,502.70 |
| Rate for Payer: Aetna Commercial |
$10,028.21
|
| Rate for Payer: Anthem Medicaid |
$4,478.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,158.45
|
| Rate for Payer: Cash Price |
$6,511.82
|
| Rate for Payer: Cigna Commercial |
$10,809.63
|
| Rate for Payer: First Health Commercial |
$12,372.47
|
| Rate for Payer: Humana Commercial |
$11,070.10
|
| Rate for Payer: Humana KY Medicaid |
$4,478.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,524.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,679.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,611.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,907.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,568.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,986.32
|
| Rate for Payer: PHCS Commercial |
$12,502.70
|
| Rate for Payer: United Healthcare All Payer |
$11,460.81
|
|
|
STENT WALLFLEX 22*90MM 10FR
|
Facility
|
OP
|
$13,023.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.09 |
| Max. Negotiated Rate |
$12,502.70 |
| Rate for Payer: Aetna Commercial |
$10,028.21
|
| Rate for Payer: Anthem Medicaid |
$4,478.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,158.45
|
| Rate for Payer: Cash Price |
$6,511.82
|
| Rate for Payer: Cigna Commercial |
$10,809.63
|
| Rate for Payer: First Health Commercial |
$12,372.47
|
| Rate for Payer: Humana Commercial |
$11,070.10
|
| Rate for Payer: Humana KY Medicaid |
$4,478.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,524.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,679.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,611.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,907.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,568.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,986.32
|
| Rate for Payer: PHCS Commercial |
$12,502.70
|
| Rate for Payer: United Healthcare All Payer |
$11,460.81
|
|
|
STENT WALLFLEX 22*90MM 10FR
|
Facility
|
IP
|
$13,023.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.09 |
| Max. Negotiated Rate |
$12,502.70 |
| Rate for Payer: Aetna Commercial |
$10,028.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,158.45
|
| Rate for Payer: Cash Price |
$6,511.82
|
| Rate for Payer: Cigna Commercial |
$10,809.63
|
| Rate for Payer: First Health Commercial |
$12,372.47
|
| Rate for Payer: Humana Commercial |
$11,070.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,679.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,611.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,907.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,986.32
|
| Rate for Payer: PHCS Commercial |
$12,502.70
|
| Rate for Payer: United Healthcare All Payer |
$11,460.81
|
|
|
STENT WALLFLEX 25*120MM 10FR
|
Facility
|
OP
|
$12,780.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,834.18 |
| Max. Negotiated Rate |
$12,269.37 |
| Rate for Payer: Aetna Commercial |
$9,841.05
|
| Rate for Payer: Anthem Medicaid |
$4,395.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,968.86
|
| Rate for Payer: Cash Price |
$6,390.29
|
| Rate for Payer: Cigna Commercial |
$10,607.89
|
| Rate for Payer: First Health Commercial |
$12,141.56
|
| Rate for Payer: Humana Commercial |
$10,863.50
|
| Rate for Payer: Humana KY Medicaid |
$4,395.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,439.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,432.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,834.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,483.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,585.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,224.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,119.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,818.61
|
| Rate for Payer: PHCS Commercial |
$12,269.37
|
| Rate for Payer: United Healthcare All Payer |
$11,246.92
|
|
|
STENT WALLFLEX 25*120MM 10FR
|
Facility
|
IP
|
$12,780.59
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,834.18 |
| Max. Negotiated Rate |
$12,269.37 |
| Rate for Payer: Aetna Commercial |
$9,841.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,968.86
|
| Rate for Payer: Cash Price |
$6,390.29
|
| Rate for Payer: Cigna Commercial |
$10,607.89
|
| Rate for Payer: First Health Commercial |
$12,141.56
|
| Rate for Payer: Humana Commercial |
$10,863.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,432.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,834.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,585.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,224.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,119.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,818.61
|
| Rate for Payer: PHCS Commercial |
$12,269.37
|
| Rate for Payer: United Healthcare All Payer |
$11,246.92
|
|
|
STENT WALLFLEX 25*60MM 10FR
|
Facility
|
OP
|
$13,023.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.09 |
| Max. Negotiated Rate |
$12,502.70 |
| Rate for Payer: Aetna Commercial |
$10,028.21
|
| Rate for Payer: Anthem Medicaid |
$4,478.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,158.45
|
| Rate for Payer: Cash Price |
$6,511.82
|
| Rate for Payer: Cigna Commercial |
$10,809.63
|
| Rate for Payer: First Health Commercial |
$12,372.47
|
| Rate for Payer: Humana Commercial |
$11,070.10
|
| Rate for Payer: Humana KY Medicaid |
$4,478.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,524.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,679.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,611.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,907.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,568.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,986.32
|
| Rate for Payer: PHCS Commercial |
$12,502.70
|
| Rate for Payer: United Healthcare All Payer |
$11,460.81
|
|
|
STENT WALLFLEX 25*60MM 10FR
|
Facility
|
IP
|
$13,023.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.09 |
| Max. Negotiated Rate |
$12,502.70 |
| Rate for Payer: Aetna Commercial |
$10,028.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,158.45
|
| Rate for Payer: Cash Price |
$6,511.82
|
| Rate for Payer: Cigna Commercial |
$10,809.63
|
| Rate for Payer: First Health Commercial |
$12,372.47
|
| Rate for Payer: Humana Commercial |
$11,070.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,679.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,611.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,907.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,460.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,767.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,330.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,986.32
|
| Rate for Payer: PHCS Commercial |
$12,502.70
|
| Rate for Payer: United Healthcare All Payer |
$11,460.81
|
|
|
STENT WALLFLEX 25*90MM 10FR
|
Facility
|
OP
|
$13,288.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,986.70 |
| Max. Negotiated Rate |
$12,757.43 |
| Rate for Payer: Aetna Commercial |
$10,232.52
|
| Rate for Payer: Anthem Medicaid |
$4,570.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,365.41
|
| Rate for Payer: Cash Price |
$6,644.50
|
| Rate for Payer: Cigna Commercial |
$11,029.86
|
| Rate for Payer: First Health Commercial |
$12,624.54
|
| Rate for Payer: Humana Commercial |
$11,295.64
|
| Rate for Payer: Humana KY Medicaid |
$4,570.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,896.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,807.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,986.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,661.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,694.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,966.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,631.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,561.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,169.40
|
| Rate for Payer: PHCS Commercial |
$12,757.43
|
| Rate for Payer: United Healthcare All Payer |
$11,694.31
|
|
|
STENT WALLFLEX 25*90MM 10FR
|
Facility
|
IP
|
$13,288.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,986.70 |
| Max. Negotiated Rate |
$12,757.43 |
| Rate for Payer: Aetna Commercial |
$10,232.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,365.41
|
| Rate for Payer: Cash Price |
$6,644.50
|
| Rate for Payer: Cigna Commercial |
$11,029.86
|
| Rate for Payer: First Health Commercial |
$12,624.54
|
| Rate for Payer: Humana Commercial |
$11,295.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,896.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,807.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,986.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,694.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,966.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,631.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,561.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,169.40
|
| Rate for Payer: PHCS Commercial |
$12,757.43
|
| Rate for Payer: United Healthcare All Payer |
$11,694.31
|
|
|
STENT WALLFLEX BIL 8MM*100MM
|
Facility
|
IP
|
$9,715.38
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.61 |
| Max. Negotiated Rate |
$9,326.76 |
| Rate for Payer: Aetna Commercial |
$7,480.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.00
|
| Rate for Payer: Cash Price |
$4,857.69
|
| Rate for Payer: Cigna Commercial |
$8,063.77
|
| Rate for Payer: First Health Commercial |
$9,229.61
|
| Rate for Payer: Humana Commercial |
$8,258.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,966.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,169.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,549.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,286.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,703.61
|
| Rate for Payer: PHCS Commercial |
$9,326.76
|
| Rate for Payer: United Healthcare All Payer |
$8,549.53
|
|
