|
WALL-STENT 8*47
|
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*60
|
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*60
|
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*66
|
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*66
|
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*80
|
Facility
|
IP
|
$8,910.74
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 8*80
|
Facility
|
OP
|
$8,910.74
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*18*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 9*18*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 9*18*160
|
Facility
|
IP
|
$7,096.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*18*160
|
Facility
|
OP
|
$7,096.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*35*100
|
Facility
|
IP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*35*100
|
Facility
|
OP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*52
|
Facility
|
IP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 9*52
|
Facility
|
OP
|
$5,698.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 CAROTID 10*24
|
Facility
|
IP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
WALL-STENT CAROTID 10*24
|
Facility
|
OP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem Medicaid |
$4,926.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Humana KY Medicaid |
$4,926.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,977.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
WALL-STENT CAROTID 10*31
|
Facility
|
IP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
WALL-STENT CAROTID 10*31
|
Facility
|
OP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem Medicaid |
$4,926.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Humana KY Medicaid |
$4,926.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,977.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
WALL-STENT CAROTID 10*37
|
Facility
|
IP
|
$12,933.18
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,879.95 |
| Max. Negotiated Rate |
$12,415.85 |
| Rate for Payer: Aetna Commercial |
$9,958.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,087.88
|
| Rate for Payer: Cash Price |
$6,466.59
|
| Rate for Payer: Cigna Commercial |
$10,734.54
|
| Rate for Payer: First Health Commercial |
$12,286.52
|
| Rate for Payer: Humana Commercial |
$10,993.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,605.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,544.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,879.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,381.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,699.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,346.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,251.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,923.89
|
| Rate for Payer: PHCS Commercial |
$12,415.85
|
| Rate for Payer: United Healthcare All Payer |
$11,381.20
|
|
|
WALL-STENT CAROTID 10*37
|
Facility
|
OP
|
$12,933.18
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,879.95 |
| Max. Negotiated Rate |
$12,415.85 |
| Rate for Payer: Aetna Commercial |
$9,958.55
|
| Rate for Payer: Anthem Medicaid |
$4,447.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,087.88
|
| Rate for Payer: Cash Price |
$6,466.59
|
| Rate for Payer: Cigna Commercial |
$10,734.54
|
| Rate for Payer: First Health Commercial |
$12,286.52
|
| Rate for Payer: Humana Commercial |
$10,993.20
|
| Rate for Payer: Humana KY Medicaid |
$4,447.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,492.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,605.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,544.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,879.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,536.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,381.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,699.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,346.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,251.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,923.89
|
| Rate for Payer: PHCS Commercial |
$12,415.85
|
| Rate for Payer: United Healthcare All Payer |
$11,381.20
|
|
|
WALL-STENT CAROTID 6*22
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
WALL-STENT CAROTID 6*22
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
WALL-STENT CAROTID 8*21
|
Facility
|
OP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem Medicaid |
$4,926.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Humana KY Medicaid |
$4,926.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,977.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
WALL-STENT CAROTID 8*21
|
Facility
|
IP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
