|
WALL-STENT 5*20*75
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 5*20*75
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 5*40*160
|
Facility
|
IP
|
$7,477.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.24 |
| Max. Negotiated Rate |
$7,178.36 |
| Rate for Payer: Aetna Commercial |
$5,757.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,832.42
|
| Rate for Payer: Cash Price |
$3,738.73
|
| Rate for Payer: Cigna Commercial |
$6,206.29
|
| Rate for Payer: First Health Commercial |
$7,103.59
|
| Rate for Payer: Humana Commercial |
$6,355.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,131.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,518.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,580.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,608.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,981.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,505.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,159.45
|
| Rate for Payer: PHCS Commercial |
$7,178.36
|
| Rate for Payer: United Healthcare All Payer |
$6,580.16
|
|
|
WALL-STENT 5*40*160
|
Facility
|
OP
|
$7,477.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.24 |
| Max. Negotiated Rate |
$7,178.36 |
| Rate for Payer: Aetna Commercial |
$5,757.64
|
| Rate for Payer: Anthem Medicaid |
$2,571.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,832.42
|
| Rate for Payer: Cash Price |
$3,738.73
|
| Rate for Payer: Cigna Commercial |
$6,206.29
|
| Rate for Payer: First Health Commercial |
$7,103.59
|
| Rate for Payer: Humana Commercial |
$6,355.84
|
| Rate for Payer: Humana KY Medicaid |
$2,571.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,597.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,131.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,518.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,623.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,580.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,608.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,981.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,505.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,159.45
|
| Rate for Payer: PHCS Commercial |
$7,178.36
|
| Rate for Payer: United Healthcare All Payer |
$6,580.16
|
|
|
WALL-STENT 6*24*160
|
Facility
|
IP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 6*24*160
|
Facility
|
OP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem Medicaid |
$2,407.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Humana KY Medicaid |
$2,407.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,432.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 6*24*75 ILIAC 6F
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 6*24*75 ILIAC 6F
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 6*36*160
|
Facility
|
IP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 6*36*160
|
Facility
|
OP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem Medicaid |
$2,407.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Humana KY Medicaid |
$2,407.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,432.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 7*23*100
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 7*23*100
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 7*23*160
|
Facility
|
IP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 7*23*160
|
Facility
|
OP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem Medicaid |
$2,407.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Humana KY Medicaid |
$2,407.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,432.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 7*34*160
|
Facility
|
OP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem Medicaid |
$2,407.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Humana KY Medicaid |
$2,407.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,432.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 7*34*160
|
Facility
|
IP
|
$7,001.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.34 |
| Max. Negotiated Rate |
$6,721.08 |
| Rate for Payer: Aetna Commercial |
$5,390.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.88
|
| Rate for Payer: Cash Price |
$3,500.56
|
| Rate for Payer: Cigna Commercial |
$5,810.94
|
| Rate for Payer: First Health Commercial |
$6,651.07
|
| Rate for Payer: Humana Commercial |
$5,950.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.78
|
| Rate for Payer: PHCS Commercial |
$6,721.08
|
| Rate for Payer: United Healthcare All Payer |
$6,160.99
|
|
|
WALL-STENT 8*20
|
Facility
|
OP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*20
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*20*75 ILIAC 6F
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 8*20*75 ILIAC 6F
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
WALL-STENT 8*38*100
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*38*100
|
Facility
|
OP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*40
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*40
|
Facility
|
OP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*47
|
Facility
|
IP
|
$6,685.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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
|
|
