|
VYEPTI 1MG(100MG SDV)
|
Facility
|
IP
|
$10,290.42
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
25004549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,087.13 |
| Max. Negotiated Rate |
$9,878.80 |
| Rate for Payer: Aetna Commercial |
$7,923.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,026.53
|
| Rate for Payer: Cash Price |
$5,145.21
|
| Rate for Payer: Cigna Commercial |
$8,541.05
|
| Rate for Payer: First Health Commercial |
$9,775.90
|
| Rate for Payer: Humana Commercial |
$8,746.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,438.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,594.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,087.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,055.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,717.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,232.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,952.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,100.39
|
| Rate for Payer: PHCS Commercial |
$9,878.80
|
| Rate for Payer: United Healthcare All Payer |
$9,055.57
|
|
|
VYEPTI 1MG(100MG SDV)
|
Facility
|
OP
|
$10,290.42
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
25004549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$9,878.80 |
| Rate for Payer: Aetna Commercial |
$7,923.62
|
| Rate for Payer: Anthem Medicaid |
$3,538.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,026.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.80
|
| Rate for Payer: Cash Price |
$5,145.21
|
| Rate for Payer: Cash Price |
$5,145.21
|
| Rate for Payer: Cigna Commercial |
$8,541.05
|
| Rate for Payer: First Health Commercial |
$9,775.90
|
| Rate for Payer: Humana Commercial |
$8,746.86
|
| Rate for Payer: Humana KY Medicaid |
$3,538.88
|
| Rate for Payer: Humana Medicare Advantage |
$19.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,574.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,438.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,594.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,609.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,055.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,717.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,232.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,952.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,100.39
|
| Rate for Payer: PHCS Commercial |
$9,878.80
|
| Rate for Payer: United Healthcare All Payer |
$9,055.57
|
|
|
VZV PCR
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$321.20
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
VZV PCR
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$321.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| 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 |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
WALL-STENT 10*20*100
|
Facility
|
IP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.43 |
| Max. Negotiated Rate |
$5,470.18 |
| Rate for Payer: Aetna Commercial |
$4,387.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.52
|
| Rate for Payer: Cash Price |
$2,849.05
|
| Rate for Payer: Cigna Commercial |
$4,729.42
|
| Rate for Payer: First Health Commercial |
$5,413.19
|
| Rate for Payer: Humana Commercial |
$4,843.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,558.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,957.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,931.69
|
| Rate for Payer: PHCS Commercial |
$5,470.18
|
| Rate for Payer: United Healthcare All Payer |
$5,014.33
|
|
|
WALL-STENT 10*20*100
|
Facility
|
OP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.43 |
| Max. Negotiated Rate |
$5,470.18 |
| Rate for Payer: Aetna Commercial |
$4,387.54
|
| Rate for Payer: Anthem Medicaid |
$1,959.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.52
|
| Rate for Payer: Cash Price |
$2,849.05
|
| Rate for Payer: Cigna Commercial |
$4,729.42
|
| Rate for Payer: First Health Commercial |
$5,413.19
|
| Rate for Payer: Humana Commercial |
$4,843.39
|
| Rate for Payer: Humana KY Medicaid |
$1,959.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,979.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,998.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,558.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,957.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,931.69
|
| Rate for Payer: PHCS Commercial |
$5,470.18
|
| Rate for Payer: United Healthcare All Payer |
$5,014.33
|
|
|
WALL-STENT 10*20*75
|
Facility
|
OP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.56 |
| Max. Negotiated Rate |
$6,417.78 |
| Rate for Payer: Aetna Commercial |
$5,147.60
|
| Rate for Payer: Anthem Medicaid |
$2,299.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,214.45
|
| Rate for Payer: Cash Price |
$3,342.59
|
| Rate for Payer: Cigna Commercial |
$5,548.71
|
| Rate for Payer: First Health Commercial |
$6,350.93
|
| Rate for Payer: Humana Commercial |
$5,682.41
|
| Rate for Payer: Humana KY Medicaid |
$2,299.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,481.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,933.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,345.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,882.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,013.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,348.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,816.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,612.78
|
| Rate for Payer: PHCS Commercial |
$6,417.78
|
| Rate for Payer: United Healthcare All Payer |
$5,882.97
|
|
|
WALL-STENT 10*20*75
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.56 |
| Max. Negotiated Rate |
$6,417.78 |
| Rate for Payer: Aetna Commercial |
$5,147.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,214.45
|
| Rate for Payer: Cash Price |
$3,342.59
|
| Rate for Payer: Cigna Commercial |
$5,548.71
|
| Rate for Payer: First Health Commercial |
$6,350.93
|
| Rate for Payer: Humana Commercial |
$5,682.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,481.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,933.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,882.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,013.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,348.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,816.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,612.78
|
| Rate for Payer: PHCS Commercial |
$6,417.78
|
| Rate for Payer: United Healthcare All Payer |
$5,882.97
|
|
|
WALL-STENT 10*39*100
|
Facility
|
IP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.43 |
| Max. Negotiated Rate |
$5,470.18 |
| Rate for Payer: Aetna Commercial |
$4,387.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.52
|
| Rate for Payer: Cash Price |
$2,849.05
|
| Rate for Payer: Cigna Commercial |
$4,729.42
|
| Rate for Payer: First Health Commercial |
$5,413.19
|
| Rate for Payer: Humana Commercial |
$4,843.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,558.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,957.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,931.69
|
| Rate for Payer: PHCS Commercial |
$5,470.18
|
| Rate for Payer: United Healthcare All Payer |
$5,014.33
|
|
|
WALL-STENT 10*39*100
|
Facility
|
OP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.43 |
| Max. Negotiated Rate |
$5,470.18 |
| Rate for Payer: Aetna Commercial |
$4,387.54
|
| Rate for Payer: Anthem Medicaid |
$1,959.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,444.52
|
| Rate for Payer: Cash Price |
$2,849.05
|
| Rate for Payer: Cigna Commercial |
$4,729.42
|
| Rate for Payer: First Health Commercial |
$5,413.19
|
| Rate for Payer: Humana Commercial |
$4,843.39
|
| Rate for Payer: Humana KY Medicaid |
$1,959.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,979.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,672.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,205.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,709.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,998.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,014.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,273.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,558.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,957.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,931.69
|
| Rate for Payer: PHCS Commercial |
$5,470.18
|
| Rate for Payer: United Healthcare All Payer |
$5,014.33
|
|
|
WALL-STENT 10*39*135
|
Facility
|
IP
|
$7,096.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.92 |
| Max. Negotiated Rate |
$6,812.54 |
| Rate for Payer: Aetna Commercial |
$5,464.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.19
|
| Rate for Payer: Cash Price |
$3,548.20
|
| Rate for Payer: Cigna Commercial |
$5,890.01
|
| Rate for Payer: First Health Commercial |
$6,741.58
|
| Rate for Payer: Humana Commercial |
$6,031.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,244.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,677.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,173.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.52
|
| Rate for Payer: PHCS Commercial |
$6,812.54
|
| Rate for Payer: United Healthcare All Payer |
$6,244.83
|
|
|
WALL-STENT 10*39*135
|
Facility
|
OP
|
$7,096.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.92 |
| Max. Negotiated Rate |
$6,812.54 |
| Rate for Payer: Aetna Commercial |
$5,464.23
|
| Rate for Payer: Anthem Medicaid |
$2,440.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.19
|
| Rate for Payer: Cash Price |
$3,548.20
|
| Rate for Payer: Cigna Commercial |
$5,890.01
|
| Rate for Payer: First Health Commercial |
$6,741.58
|
| Rate for Payer: Humana Commercial |
$6,031.94
|
| Rate for Payer: Humana KY Medicaid |
$2,440.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,465.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,244.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,677.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,173.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,896.52
|
| Rate for Payer: PHCS Commercial |
$6,812.54
|
| Rate for Payer: United Healthcare All Payer |
$6,244.83
|
|
|
WALL-STENT 10*42*75
|
Facility
|
OP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.56 |
| Max. Negotiated Rate |
$6,417.78 |
| Rate for Payer: Aetna Commercial |
$5,147.60
|
| Rate for Payer: Anthem Medicaid |
$2,299.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,214.45
|
| Rate for Payer: Cash Price |
$3,342.59
|
| Rate for Payer: Cigna Commercial |
$5,548.71
|
| Rate for Payer: First Health Commercial |
$6,350.93
|
| Rate for Payer: Humana Commercial |
$5,682.41
|
| Rate for Payer: Humana KY Medicaid |
$2,299.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,481.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,933.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,345.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,882.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,013.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,348.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,816.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,612.78
|
| Rate for Payer: PHCS Commercial |
$6,417.78
|
| Rate for Payer: United Healthcare All Payer |
$5,882.97
|
|
|
WALL-STENT 10*42*75
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.56 |
| Max. Negotiated Rate |
$6,417.78 |
| Rate for Payer: Aetna Commercial |
$5,147.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,214.45
|
| Rate for Payer: Cash Price |
$3,342.59
|
| Rate for Payer: Cigna Commercial |
$5,548.71
|
| Rate for Payer: First Health Commercial |
$6,350.93
|
| Rate for Payer: Humana Commercial |
$5,682.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,481.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,933.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,882.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,013.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,348.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,816.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,612.78
|
| Rate for Payer: PHCS Commercial |
$6,417.78
|
| Rate for Payer: United Healthcare All Payer |
$5,882.97
|
|
|
WALL-STENT 10*49*75
|
Facility
|
OP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.56 |
| Max. Negotiated Rate |
$6,417.78 |
| Rate for Payer: Aetna Commercial |
$5,147.60
|
| Rate for Payer: Anthem Medicaid |
$2,299.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,214.45
|
| Rate for Payer: Cash Price |
$3,342.59
|
| Rate for Payer: Cigna Commercial |
$5,548.71
|
| Rate for Payer: First Health Commercial |
$6,350.93
|
| Rate for Payer: Humana Commercial |
$5,682.41
|
| Rate for Payer: Humana KY Medicaid |
$2,299.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,481.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,933.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,345.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,882.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,013.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,348.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,816.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,612.78
|
| Rate for Payer: PHCS Commercial |
$6,417.78
|
| Rate for Payer: United Healthcare All Payer |
$5,882.97
|
|
|
WALL-STENT 10*49*75
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.56 |
| Max. Negotiated Rate |
$6,417.78 |
| Rate for Payer: Aetna Commercial |
$5,147.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,214.45
|
| Rate for Payer: Cash Price |
$3,342.59
|
| Rate for Payer: Cigna Commercial |
$5,548.71
|
| Rate for Payer: First Health Commercial |
$6,350.93
|
| Rate for Payer: Humana Commercial |
$5,682.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,481.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,933.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,005.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,882.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,013.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,348.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,816.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,612.78
|
| Rate for Payer: PHCS Commercial |
$6,417.78
|
| Rate for Payer: United Healthcare All Payer |
$5,882.97
|
|
|
WALL-STENT 10*69*75
|
Facility
|
IP
|
$8,910.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.22 |
| Max. Negotiated Rate |
$8,554.31 |
| Rate for Payer: Aetna Commercial |
$6,861.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,455.37
|
| Rate for Payer: Cigna Commercial |
$7,395.91
|
| Rate for Payer: First Health Commercial |
$8,465.20
|
| Rate for Payer: Humana Commercial |
$7,574.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,576.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,683.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,752.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.41
|
| Rate for Payer: PHCS Commercial |
$8,554.31
|
| Rate for Payer: United Healthcare All Payer |
$7,841.45
|
|
|
WALL-STENT 10*69*75
|
Facility
|
OP
|
$8,910.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.22 |
| Max. Negotiated Rate |
$8,554.31 |
| Rate for Payer: Aetna Commercial |
$6,861.27
|
| Rate for Payer: Anthem Medicaid |
$3,064.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.38
|
| Rate for Payer: Cash Price |
$4,455.37
|
| Rate for Payer: Cigna Commercial |
$7,395.91
|
| Rate for Payer: First Health Commercial |
$8,465.20
|
| Rate for Payer: Humana Commercial |
$7,574.13
|
| Rate for Payer: Humana KY Medicaid |
$3,064.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,095.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,576.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,125.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,683.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,752.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.41
|
| Rate for Payer: PHCS Commercial |
$8,554.31
|
| Rate for Payer: United Healthcare All Payer |
$7,841.45
|
|
|
WALL-STENT 12*40
|
Facility
|
OP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem Medicaid |
$1,822.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Humana KY Medicaid |
$1,822.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
WALL-STENT 12*40
|
Facility
|
IP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
|
WALL-STENT 12*60
|
Facility
|
IP
|
$6,795.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.52 |
| Max. Negotiated Rate |
$6,523.25 |
| Rate for Payer: Aetna Commercial |
$5,232.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.14
|
| Rate for Payer: Cash Price |
$3,397.53
|
| Rate for Payer: Cigna Commercial |
$5,639.89
|
| Rate for Payer: First Health Commercial |
$6,455.30
|
| Rate for Payer: Humana Commercial |
$5,775.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,571.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.58
|
| Rate for Payer: PHCS Commercial |
$6,523.25
|
| Rate for Payer: United Healthcare All Payer |
$5,979.64
|
|
|
WALL-STENT 12*60
|
Facility
|
OP
|
$6,795.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.52 |
| Max. Negotiated Rate |
$6,523.25 |
| Rate for Payer: Aetna Commercial |
$5,232.19
|
| Rate for Payer: Anthem Medicaid |
$2,336.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.14
|
| Rate for Payer: Cash Price |
$3,397.53
|
| Rate for Payer: Cigna Commercial |
$5,639.89
|
| Rate for Payer: First Health Commercial |
$6,455.30
|
| Rate for Payer: Humana Commercial |
$5,775.79
|
| Rate for Payer: Humana KY Medicaid |
$2,336.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,571.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.58
|
| Rate for Payer: PHCS Commercial |
$6,523.25
|
| Rate for Payer: United Healthcare All Payer |
$5,979.64
|
|
|
WALL-STENT 14*20
|
Facility
|
IP
|
$6,795.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.52 |
| Max. Negotiated Rate |
$6,523.25 |
| Rate for Payer: Aetna Commercial |
$5,232.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.14
|
| Rate for Payer: Cash Price |
$3,397.53
|
| Rate for Payer: Cigna Commercial |
$5,639.89
|
| Rate for Payer: First Health Commercial |
$6,455.30
|
| Rate for Payer: Humana Commercial |
$5,775.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,571.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.58
|
| Rate for Payer: PHCS Commercial |
$6,523.25
|
| Rate for Payer: United Healthcare All Payer |
$5,979.64
|
|
|
WALL-STENT 14*20
|
Facility
|
OP
|
$6,795.05
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.52 |
| Max. Negotiated Rate |
$6,523.25 |
| Rate for Payer: Aetna Commercial |
$5,232.19
|
| Rate for Payer: Anthem Medicaid |
$2,336.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.14
|
| Rate for Payer: Cash Price |
$3,397.53
|
| Rate for Payer: Cigna Commercial |
$5,639.89
|
| Rate for Payer: First Health Commercial |
$6,455.30
|
| Rate for Payer: Humana Commercial |
$5,775.79
|
| Rate for Payer: Humana KY Medicaid |
$2,336.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,571.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.58
|
| Rate for Payer: PHCS Commercial |
$6,523.25
|
| Rate for Payer: United Healthcare All Payer |
$5,979.64
|
|
|
WALL-STENT 14*40
|
Facility
|
IP
|
$5,300.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.00 |
| Max. Negotiated Rate |
$5,088.00 |
| Rate for Payer: Aetna Commercial |
$4,081.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,650.00
|
| Rate for Payer: Cigna Commercial |
$4,399.00
|
| Rate for Payer: First Health Commercial |
$5,035.00
|
| Rate for Payer: Humana Commercial |
$4,505.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,346.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,911.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,664.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,611.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,657.00
|
| Rate for Payer: PHCS Commercial |
$5,088.00
|
| Rate for Payer: United Healthcare All Payer |
$4,664.00
|
|
