|
EPHEDRINE 50 MG/1 ML
|
Facility
|
IP
|
$203.29
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
25003044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$195.16 |
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.57
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna Commercial |
$168.73
|
| Rate for Payer: First Health Commercial |
$193.13
|
| Rate for Payer: Humana Commercial |
$172.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.90
|
| Rate for Payer: Ohio Health Group HMO |
$152.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.02
|
| Rate for Payer: PHCS Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Payer |
$178.90
|
|
|
EPHEDRINE 50 MG/1 ML
|
Facility
|
OP
|
$203.29
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
25003044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$195.16 |
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Anthem Medicaid |
$69.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.57
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna Commercial |
$168.73
|
| Rate for Payer: First Health Commercial |
$193.13
|
| Rate for Payer: Humana Commercial |
$172.80
|
| Rate for Payer: Humana KY Medicaid |
$69.91
|
| Rate for Payer: Kentucky WC Medicaid |
$70.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.90
|
| Rate for Payer: Ohio Health Group HMO |
$152.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.02
|
| Rate for Payer: PHCS Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Payer |
$178.90
|
|
|
EPHEDRINE 5MG/ML 10ML SYRINGE
|
Facility
|
IP
|
$203.29
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
25003045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$195.16 |
| Rate for Payer: Humana Commercial |
$172.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.90
|
| Rate for Payer: Ohio Health Group HMO |
$152.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.02
|
| Rate for Payer: PHCS Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Payer |
$178.90
|
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.57
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna Commercial |
$168.73
|
| Rate for Payer: First Health Commercial |
$193.13
|
|
|
EPHEDRINE 5MG/ML 10ML SYRINGE
|
Facility
|
OP
|
$203.29
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
25003045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$195.16 |
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Anthem Medicaid |
$69.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.57
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna Commercial |
$168.73
|
| Rate for Payer: First Health Commercial |
$193.13
|
| Rate for Payer: Humana Commercial |
$172.80
|
| Rate for Payer: Humana KY Medicaid |
$69.91
|
| Rate for Payer: Kentucky WC Medicaid |
$70.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.90
|
| Rate for Payer: Ohio Health Group HMO |
$152.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.02
|
| Rate for Payer: PHCS Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Payer |
$178.90
|
|
|
EPIC STENT 120CM 10*30
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 10*30
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 10*40
|
Facility
|
OP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem Medicaid |
$1,460.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Humana KY Medicaid |
$1,460.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
EPIC STENT 120CM 10*40
|
Facility
|
IP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
EPIC STENT 120CM 10*50
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 10*50
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 12*30
|
Facility
|
IP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
EPIC STENT 120CM 12*30
|
Facility
|
OP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem Medicaid |
$1,460.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Humana KY Medicaid |
$1,460.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
EPIC STENT 120CM 12*40
|
Facility
|
OP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem Medicaid |
$2,375.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Humana KY Medicaid |
$2,375.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
EPIC STENT 120CM 12*40
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
EPIC STENT 120CM 12*50
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 12*50
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 6*100
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
EPIC STENT 120CM 6*100
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
EPIC STENT 120CM 6*120
|
Facility
|
IP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
EPIC STENT 120CM 6*120
|
Facility
|
OP
|
$5,612.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.62 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna Commercial |
$4,321.62
|
| Rate for Payer: Anthem Medicaid |
$1,930.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,377.75
|
| Rate for Payer: Cash Price |
$2,806.25
|
| Rate for Payer: Cigna Commercial |
$4,658.38
|
| Rate for Payer: First Health Commercial |
$5,331.88
|
| Rate for Payer: Humana Commercial |
$4,770.62
|
| Rate for Payer: Humana KY Medicaid |
$1,930.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,602.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,142.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,739.88
|
| Rate for Payer: PHCS Commercial |
$5,388.00
|
| Rate for Payer: United Healthcare All Payer |
$4,939.00
|
|
|
EPIC STENT 120CM 6*20
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
EPIC STENT 120CM 6*20
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
EPIC STENT 120CM 6*30
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
EPIC STENT 120CM 6*30
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
EPIC STENT 120CM 6*40
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
