|
WALL-STENT 8*20*75 ILIAC 6F
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 8*20*75 ILIAC 6F
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 8*38*100
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*38*100
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*40
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*40
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*47
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*47
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*60
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*60
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*66
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*66
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*80
|
Facility
|
OP
|
$8,710.74
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*80
|
Facility
|
IP
|
$8,710.74
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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
|
|
|
WALL-STENT 9*18*100
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*18*100
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*18*160
|
Facility
|
OP
|
$6,896.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*18*160
|
Facility
|
IP
|
$6,896.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*35*100
|
Facility
|
OP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*35*100
|
Facility
|
IP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*52
|
Facility
|
IP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*52
|
Facility
|
OP
|
$5,651.56
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 CAROTID 10*24
|
Facility
|
IP
|
$12,881.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.56 |
| Max. Negotiated Rate |
$12,366.00 |
| Rate for Payer: Aetna Commercial |
$9,918.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,047.38
|
| Rate for Payer: Cash Price |
$6,440.62
|
| Rate for Payer: Cigna Commercial |
$10,691.44
|
| Rate for Payer: First Health Commercial |
$12,237.19
|
| Rate for Payer: Humana Commercial |
$10,949.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,562.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,506.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,864.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,335.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,660.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,576.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,993.19
|
| Rate for Payer: PHCS Commercial |
$12,366.00
|
| Rate for Payer: United Healthcare All Payer |
$11,335.50
|
|
|
WALL-STENT CAROTID 10*24
|
Facility
|
OP
|
$12,881.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.56 |
| Max. Negotiated Rate |
$12,366.00 |
| Rate for Payer: Aetna Commercial |
$9,918.56
|
| Rate for Payer: Anthem Medicaid |
$4,429.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,047.38
|
| Rate for Payer: Cash Price |
$6,440.62
|
| Rate for Payer: Cigna Commercial |
$10,691.44
|
| Rate for Payer: First Health Commercial |
$12,237.19
|
| Rate for Payer: Humana Commercial |
$10,949.06
|
| Rate for Payer: Humana KY Medicaid |
$4,429.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,474.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,562.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,506.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,864.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,335.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,660.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,576.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,993.19
|
| Rate for Payer: PHCS Commercial |
$12,366.00
|
| Rate for Payer: United Healthcare All Payer |
$11,335.50
|
|
|
WALL-STENT CAROTID 10*31
|
Facility
|
OP
|
$9,370.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.10 |
| Max. Negotiated Rate |
$8,995.20 |
| Rate for Payer: Aetna Commercial |
$7,214.90
|
| Rate for Payer: Anthem Medicaid |
$3,222.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,308.60
|
| Rate for Payer: Cash Price |
$4,685.00
|
| Rate for Payer: Cigna Commercial |
$7,777.10
|
| Rate for Payer: First Health Commercial |
$8,901.50
|
| Rate for Payer: Humana Commercial |
$7,964.50
|
| Rate for Payer: Humana KY Medicaid |
$3,222.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,255.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,683.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,915.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,811.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,287.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,245.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.70
|
| Rate for Payer: PHCS Commercial |
$8,995.20
|
| Rate for Payer: United Healthcare All Payer |
$8,245.60
|
|
