|
WALL-STENT 12*40
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 12*40
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 12*60
|
Facility
|
OP
|
$6,595.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.36 |
| Max. Negotiated Rate |
$6,331.25 |
| Rate for Payer: Aetna Commercial |
$5,078.19
|
| Rate for Payer: Anthem Medicaid |
$2,268.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.14
|
| Rate for Payer: Cash Price |
$3,297.53
|
| Rate for Payer: Cigna Commercial |
$5,473.89
|
| Rate for Payer: First Health Commercial |
$6,265.30
|
| Rate for Payer: Humana Commercial |
$5,605.79
|
| Rate for Payer: Humana KY Medicaid |
$2,268.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,313.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,803.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,946.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.47
|
| Rate for Payer: PHCS Commercial |
$6,331.25
|
| Rate for Payer: United Healthcare All Payer |
$5,803.64
|
|
|
WALL-STENT 12*60
|
Facility
|
IP
|
$6,595.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.36 |
| Max. Negotiated Rate |
$6,331.25 |
| Rate for Payer: Aetna Commercial |
$5,078.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.14
|
| Rate for Payer: Cash Price |
$3,297.53
|
| Rate for Payer: Cigna Commercial |
$5,473.89
|
| Rate for Payer: First Health Commercial |
$6,265.30
|
| Rate for Payer: Humana Commercial |
$5,605.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,803.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,946.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.47
|
| Rate for Payer: PHCS Commercial |
$6,331.25
|
| Rate for Payer: United Healthcare All Payer |
$5,803.64
|
|
|
WALL-STENT 14*20
|
Facility
|
OP
|
$6,595.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.36 |
| Max. Negotiated Rate |
$6,331.25 |
| Rate for Payer: Aetna Commercial |
$5,078.19
|
| Rate for Payer: Anthem Medicaid |
$2,268.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.14
|
| Rate for Payer: Cash Price |
$3,297.53
|
| Rate for Payer: Cigna Commercial |
$5,473.89
|
| Rate for Payer: First Health Commercial |
$6,265.30
|
| Rate for Payer: Humana Commercial |
$5,605.79
|
| Rate for Payer: Humana KY Medicaid |
$2,268.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,313.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,803.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,946.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.47
|
| Rate for Payer: PHCS Commercial |
$6,331.25
|
| Rate for Payer: United Healthcare All Payer |
$5,803.64
|
|
|
WALL-STENT 14*20
|
Facility
|
IP
|
$6,595.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.36 |
| Max. Negotiated Rate |
$6,331.25 |
| Rate for Payer: Aetna Commercial |
$5,078.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.14
|
| Rate for Payer: Cash Price |
$3,297.53
|
| Rate for Payer: Cigna Commercial |
$5,473.89
|
| Rate for Payer: First Health Commercial |
$6,265.30
|
| Rate for Payer: Humana Commercial |
$5,605.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,803.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,946.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.47
|
| Rate for Payer: PHCS Commercial |
$6,331.25
|
| Rate for Payer: United Healthcare All Payer |
$5,803.64
|
|
|
WALL-STENT 14*40
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 14*40
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 14*60
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 14*60
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 16*20
|
Facility
|
IP
|
$6,595.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.36 |
| Max. Negotiated Rate |
$6,331.25 |
| Rate for Payer: Aetna Commercial |
$5,078.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.14
|
| Rate for Payer: Cash Price |
$3,297.53
|
| Rate for Payer: Cigna Commercial |
$5,473.89
|
| Rate for Payer: First Health Commercial |
$6,265.30
|
| Rate for Payer: Humana Commercial |
$5,605.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,803.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,946.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.47
|
| Rate for Payer: PHCS Commercial |
$6,331.25
|
| Rate for Payer: United Healthcare All Payer |
$5,803.64
|
|
|
WALL-STENT 16*20
|
Facility
|
OP
|
$6,595.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.36 |
| Max. Negotiated Rate |
$6,331.25 |
| Rate for Payer: Aetna Commercial |
$5,078.19
|
| Rate for Payer: Anthem Medicaid |
$2,268.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.14
|
| Rate for Payer: Cash Price |
$3,297.53
|
| Rate for Payer: Cigna Commercial |
$5,473.89
|
| Rate for Payer: First Health Commercial |
$6,265.30
|
| Rate for Payer: Humana Commercial |
$5,605.79
|
| Rate for Payer: Humana KY Medicaid |
$2,268.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,313.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,803.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,946.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.47
|
| Rate for Payer: PHCS Commercial |
$6,331.25
|
| Rate for Payer: United Healthcare All Payer |
$5,803.64
|
|
|
WALL-STENT 16*40
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 16*40
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 16*60
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 16*60
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 18*40
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 18*40
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 18*90*75
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
WALL-STENT 18*90*75
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
WALL-STENT 20*40
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 20*40
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 20*55
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 20*55
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 22*35
|
Facility
|
OP
|
$6,920.70
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.69 |
| Max. Negotiated Rate |
$6,643.87 |
| Rate for Payer: Aetna Commercial |
$5,328.94
|
| Rate for Payer: Anthem Medicaid |
$2,380.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,398.15
|
| Rate for Payer: Cash Price |
$3,460.35
|
| Rate for Payer: Cigna Commercial |
$5,744.18
|
| Rate for Payer: First Health Commercial |
$6,574.66
|
| Rate for Payer: Humana Commercial |
$5,882.60
|
| Rate for Payer: Humana KY Medicaid |
$2,380.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,404.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,674.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,107.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,076.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,427.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,090.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,190.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,384.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,145.42
|
| Rate for Payer: PHCS Commercial |
$6,643.87
|
| Rate for Payer: United Healthcare All Payer |
$6,090.22
|
|
