|
AEROMINI TRCHOBRNC STENT 14*15
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 14*15
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 8*10
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRCHOBRNC STENT 8*10
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROSOL VENT/PERF LUNG SCAN
|
Facility
|
IP
|
$2,631.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
34000025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$789.30 |
| Max. Negotiated Rate |
$2,525.76 |
| Rate for Payer: Aetna Commercial |
$2,025.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,052.18
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cigna Commercial |
$2,183.73
|
| Rate for Payer: First Health Commercial |
$2,499.45
|
| Rate for Payer: Humana Commercial |
$2,236.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,157.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,941.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,315.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,973.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,288.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,815.39
|
| Rate for Payer: PHCS Commercial |
$2,525.76
|
| Rate for Payer: United Healthcare All Payer |
$2,315.28
|
|
|
AEROSOL VENT/PERF LUNG SCAN
|
Facility
|
OP
|
$2,631.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
34000025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$2,525.76 |
| Rate for Payer: Aetna Commercial |
$2,025.87
|
| Rate for Payer: Anthem Medicaid |
$904.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,052.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cigna Commercial |
$2,183.73
|
| Rate for Payer: First Health Commercial |
$2,499.45
|
| Rate for Payer: Humana Commercial |
$2,236.35
|
| Rate for Payer: Humana KY Medicaid |
$904.80
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$914.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,157.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,941.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$922.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,315.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,973.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,288.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,815.39
|
| Rate for Payer: PHCS Commercial |
$2,525.76
|
| Rate for Payer: United Healthcare All Payer |
$2,315.28
|
|
|
AEROSOL VENT/PERF LUNG SCAN
|
Professional
|
Both
|
$2,631.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
34000025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$1,578.60 |
| Rate for Payer: Ambetter Exchange |
$265.36
|
| Rate for Payer: Anthem Medicaid |
$247.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$265.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$318.43
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cigna Commercial |
$526.39
|
| Rate for Payer: Healthspan PPO |
$349.79
|
| Rate for Payer: Humana Medicaid |
$247.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$265.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.04
|
| Rate for Payer: Molina Healthcare Passport |
$247.10
|
| Rate for Payer: Multiplan PHCS |
$1,578.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$344.97
|
| Rate for Payer: UHCCP Medicaid |
$920.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$265.36
|
|
|
AEROSOL VENT/PERF LUNG SCAN(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
340P0025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$526.39 |
| Rate for Payer: Ambetter Exchange |
$265.36
|
| Rate for Payer: Anthem Medicaid |
$247.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$265.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$318.43
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$526.39
|
| Rate for Payer: Healthspan PPO |
$349.79
|
| Rate for Payer: Humana Medicaid |
$247.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$265.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.04
|
| Rate for Payer: Molina Healthcare Passport |
$247.10
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$344.97
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$265.36
|
|
|
AEROSOL VENT/PERF LUNG SCAN(T
|
Facility
|
IP
|
$2,481.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
340T0025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$744.30 |
| Max. Negotiated Rate |
$2,381.76 |
| Rate for Payer: Aetna Commercial |
$1,910.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,935.18
|
| Rate for Payer: Cash Price |
$1,240.50
|
| Rate for Payer: Cigna Commercial |
$2,059.23
|
| Rate for Payer: First Health Commercial |
$2,356.95
|
| Rate for Payer: Humana Commercial |
$2,108.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,034.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,830.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,183.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,158.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.89
|
| Rate for Payer: PHCS Commercial |
$2,381.76
|
| Rate for Payer: United Healthcare All Payer |
$2,183.28
|
|
|
AEROSOL VENT/PERF LUNG SCAN(T
|
Facility
|
OP
|
$2,481.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
340T0025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$2,381.76 |
| Rate for Payer: Aetna Commercial |
$1,910.37
|
| Rate for Payer: Anthem Medicaid |
$853.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,935.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,240.50
|
| Rate for Payer: Cash Price |
$1,240.50
|
| Rate for Payer: Cigna Commercial |
$2,059.23
|
| Rate for Payer: First Health Commercial |
$2,356.95
|
| Rate for Payer: Humana Commercial |
$2,108.85
|
| Rate for Payer: Humana KY Medicaid |
$853.22
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$861.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,034.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,830.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$870.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,183.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,158.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.89
|
| Rate for Payer: PHCS Commercial |
$2,381.76
|
| Rate for Payer: United Healthcare All Payer |
$2,183.28
|
|
|
AERO TRACHBRONCHIAL STENT 16*4
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHBRONCHIAL STENT 16*4
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
AERO TRACHEOBRONCH STENT 10*20
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 10*20
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 10*30
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 10*30
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 10*40
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 10*40
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 12*20
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 12*20
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 12*30
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 12*30
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 14*20
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 14*20
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO TRACHEOBRONCH STENT 14*3
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
