|
VPRIV 100 UNITS (400 UNIT VL)
|
Facility
|
OP
|
$7,961.69
|
|
|
Service Code
|
HCPCS J3385
|
| Hospital Charge Code |
25002420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.41 |
| Max. Negotiated Rate |
$7,643.22 |
| Rate for Payer: Aetna Commercial |
$6,130.50
|
| Rate for Payer: Anthem Medicaid |
$2,738.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$367.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,210.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$514.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$496.00
|
| Rate for Payer: Cash Price |
$3,980.84
|
| Rate for Payer: Cash Price |
$3,980.84
|
| Rate for Payer: Cigna Commercial |
$6,608.20
|
| Rate for Payer: First Health Commercial |
$7,563.61
|
| Rate for Payer: Humana Commercial |
$6,767.44
|
| Rate for Payer: Humana KY Medicaid |
$2,738.03
|
| Rate for Payer: Humana Medicare Advantage |
$367.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,765.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,528.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,875.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,792.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,006.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,971.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,592.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.12
|
| Rate for Payer: PHCS Commercial |
$7,643.22
|
| Rate for Payer: United Healthcare All Payer |
$7,006.29
|
|
|
VRAYLAR 1.5MG CAPSULE
|
Facility
|
IP
|
$83.92
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
25003588
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$80.56 |
| Rate for Payer: Aetna Commercial |
$64.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.46
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cigna Commercial |
$69.65
|
| Rate for Payer: First Health Commercial |
$79.72
|
| Rate for Payer: Humana Commercial |
$71.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.85
|
| Rate for Payer: Ohio Health Group HMO |
$62.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.02
|
| Rate for Payer: PHCS Commercial |
$80.56
|
| Rate for Payer: United Healthcare All Payer |
$73.85
|
|
|
VRAYLAR 1.5MG CAPSULE
|
Facility
|
OP
|
$83.92
|
|
|
Service Code
|
NDC 61874011511
|
| Hospital Charge Code |
25003588
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$80.56 |
| Rate for Payer: Aetna Commercial |
$64.62
|
| Rate for Payer: Anthem Medicaid |
$28.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.46
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cigna Commercial |
$69.65
|
| Rate for Payer: First Health Commercial |
$79.72
|
| Rate for Payer: Humana Commercial |
$71.33
|
| Rate for Payer: Humana KY Medicaid |
$28.86
|
| Rate for Payer: Kentucky WC Medicaid |
$29.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.85
|
| Rate for Payer: Ohio Health Group HMO |
$62.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.02
|
| Rate for Payer: PHCS Commercial |
$80.56
|
| Rate for Payer: United Healthcare All Payer |
$73.85
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 56620
|
| Hospital Charge Code |
76102162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.28 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$742.08
|
| Rate for Payer: Anthem Medicaid |
$403.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$778.07
|
| Rate for Payer: Healthspan PPO |
$718.52
|
| Rate for Payer: Humana Medicaid |
$403.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$411.35
|
| Rate for Payer: Molina Healthcare Passport |
$403.28
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$407.31
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
76102162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 56620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 56620
|
| Hospital Charge Code |
76102162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
VULVECTOMY SIMPLE; PARTIAL
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 56620
|
| Hospital Charge Code |
76102162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
VULVECTOMY SIMPLE; PARTIAL(P
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 56620
|
| Hospital Charge Code |
761P2162
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.28 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$742.08
|
| Rate for Payer: Anthem Medicaid |
$403.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$778.07
|
| Rate for Payer: Healthspan PPO |
$718.52
|
| Rate for Payer: Humana Medicaid |
$403.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$411.35
|
| Rate for Payer: Molina Healthcare Passport |
$403.28
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$407.31
|
|
|
VZV PCR
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$373.44 |
| Rate for Payer: Aetna Commercial |
$299.53
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$322.87
|
| Rate for Payer: First Health Commercial |
$369.55
|
| Rate for Payer: Humana Commercial |
$330.65
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$342.32
|
| Rate for Payer: Ohio Health Group HMO |
$291.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.59
|
| Rate for Payer: PHCS Commercial |
$373.44
|
| Rate for Payer: United Healthcare All Payer |
$342.32
|
|
|
VZV PCR
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.57 |
| Max. Negotiated Rate |
$373.44 |
| Rate for Payer: Aetna Commercial |
$299.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.37
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$322.87
|
| Rate for Payer: First Health Commercial |
$369.55
|
| Rate for Payer: Humana Commercial |
$330.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$342.32
|
| Rate for Payer: Ohio Health Group HMO |
$291.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.59
|
| Rate for Payer: PHCS Commercial |
$373.44
|
| Rate for Payer: United Healthcare All Payer |
$342.32
|
|
|
WALL-STENT 10*20*100
|
Facility
|
OP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.70 |
| Max. Negotiated Rate |
$5,425.50 |
| Rate for Payer: Aetna Commercial |
$4,351.70
|
| Rate for Payer: Anthem Medicaid |
$1,943.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,408.22
|
| Rate for Payer: Cash Price |
$2,825.78
|
| Rate for Payer: Cigna Commercial |
$4,690.79
|
| Rate for Payer: First Health Commercial |
$5,368.98
|
| Rate for Payer: Humana Commercial |
$4,803.83
|
| Rate for Payer: Humana KY Medicaid |
$1,943.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,963.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,634.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,170.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,695.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,982.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,973.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,238.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,130.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.98
|
| Rate for Payer: PHCS Commercial |
$5,425.50
|
| Rate for Payer: United Healthcare All Payer |
$4,973.37
|
|
|
WALL-STENT 10*20*100
|
Facility
|
IP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.70 |
| Max. Negotiated Rate |
$5,425.50 |
| Rate for Payer: Aetna Commercial |
$4,351.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,408.22
|
| Rate for Payer: Cash Price |
$2,825.78
|
| Rate for Payer: Cigna Commercial |
$4,690.79
|
| Rate for Payer: First Health Commercial |
$5,368.98
|
| Rate for Payer: Humana Commercial |
$4,803.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,634.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,170.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,695.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,973.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,238.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,130.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.98
|
| Rate for Payer: PHCS Commercial |
$5,425.50
|
| Rate for Payer: United Healthcare All Payer |
$4,973.37
|
|
|
WALL-STENT 10*20*75
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem Medicaid |
$2,230.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Humana KY Medicaid |
$2,230.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 10*20*75
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 10*39*100
|
Facility
|
OP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.70 |
| Max. Negotiated Rate |
$5,425.50 |
| Rate for Payer: Aetna Commercial |
$4,351.70
|
| Rate for Payer: Anthem Medicaid |
$1,943.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,408.22
|
| Rate for Payer: Cash Price |
$2,825.78
|
| Rate for Payer: Cigna Commercial |
$4,690.79
|
| Rate for Payer: First Health Commercial |
$5,368.98
|
| Rate for Payer: Humana Commercial |
$4,803.83
|
| Rate for Payer: Humana KY Medicaid |
$1,943.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,963.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,634.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,170.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,695.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,982.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,973.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,238.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,130.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.98
|
| Rate for Payer: PHCS Commercial |
$5,425.50
|
| Rate for Payer: United Healthcare All Payer |
$4,973.37
|
|
|
WALL-STENT 10*39*100
|
Facility
|
IP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.70 |
| Max. Negotiated Rate |
$5,425.50 |
| Rate for Payer: Aetna Commercial |
$4,351.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,408.22
|
| Rate for Payer: Cash Price |
$2,825.78
|
| Rate for Payer: Cigna Commercial |
$4,690.79
|
| Rate for Payer: First Health Commercial |
$5,368.98
|
| Rate for Payer: Humana Commercial |
$4,803.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,634.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,170.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,695.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,973.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,238.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,130.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,751.98
|
| Rate for Payer: PHCS Commercial |
$5,425.50
|
| Rate for Payer: United Healthcare All Payer |
$4,973.37
|
|
|
WALL-STENT 10*39*135
|
Facility
|
OP
|
$6,896.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.53 |
| Max. Negotiated Rate |
$6,620.54 |
| Rate for Payer: Aetna Commercial |
$5,310.23
|
| Rate for Payer: Anthem Medicaid |
$2,371.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,379.19
|
| Rate for Payer: Cash Price |
$3,448.20
|
| Rate for Payer: Cigna Commercial |
$5,724.01
|
| Rate for Payer: First Health Commercial |
$6,551.58
|
| Rate for Payer: Humana Commercial |
$5,861.94
|
| Rate for Payer: Humana KY Medicaid |
$2,371.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,395.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,655.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,089.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,419.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,068.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,172.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,137.88
|
| Rate for Payer: PHCS Commercial |
$6,620.54
|
| Rate for Payer: United Healthcare All Payer |
$6,068.83
|
|
|
WALL-STENT 10*39*135
|
Facility
|
IP
|
$6,896.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.53 |
| Max. Negotiated Rate |
$6,620.54 |
| Rate for Payer: Aetna Commercial |
$5,310.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,379.19
|
| Rate for Payer: Cash Price |
$3,448.20
|
| Rate for Payer: Cigna Commercial |
$5,724.01
|
| Rate for Payer: First Health Commercial |
$6,551.58
|
| Rate for Payer: Humana Commercial |
$5,861.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,655.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,089.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,068.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,172.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,137.88
|
| Rate for Payer: PHCS Commercial |
$6,620.54
|
| Rate for Payer: United Healthcare All Payer |
$6,068.83
|
|
|
WALL-STENT 10*42*75
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 10*42*75
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem Medicaid |
$2,230.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Humana KY Medicaid |
$2,230.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 10*49*75
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 10*49*75
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem Medicaid |
$2,230.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Humana KY Medicaid |
$2,230.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 10*69*75
|
Facility
|
OP
|
$8,710.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.40 |
| Max. Negotiated Rate |
$8,362.31 |
| Rate for Payer: Aetna Commercial |
$6,707.27
|
| Rate for Payer: Anthem Medicaid |
$2,995.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.38
|
| Rate for Payer: Cash Price |
$4,355.37
|
| Rate for Payer: Cigna Commercial |
$7,229.91
|
| Rate for Payer: First Health Commercial |
$8,275.20
|
| Rate for Payer: Humana Commercial |
$7,404.13
|
| Rate for Payer: Humana KY Medicaid |
$2,995.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,533.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.33
|
| Rate for Payer: PHCS Commercial |
$8,362.31
|
| Rate for Payer: United Healthcare All Payer |
$7,665.45
|
|
|
WALL-STENT 10*69*75
|
Facility
|
IP
|
$8,710.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.40 |
| Max. Negotiated Rate |
$8,362.31 |
| Rate for Payer: Aetna Commercial |
$6,707.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.38
|
| Rate for Payer: Cash Price |
$4,355.37
|
| Rate for Payer: Cigna Commercial |
$7,229.91
|
| Rate for Payer: First Health Commercial |
$8,275.20
|
| Rate for Payer: Humana Commercial |
$7,404.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,533.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.33
|
| Rate for Payer: PHCS Commercial |
$8,362.31
|
| Rate for Payer: United Healthcare All Payer |
$7,665.45
|
|
