|
EONC NON-RECHARABLE IPG 3688
|
Facility
|
IP
|
$82,909.95
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,872.99 |
| Max. Negotiated Rate |
$79,593.55 |
| Rate for Payer: Aetna Commercial |
$63,840.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,669.76
|
| Rate for Payer: Cash Price |
$41,454.97
|
| Rate for Payer: Cigna Commercial |
$68,815.26
|
| Rate for Payer: First Health Commercial |
$78,764.45
|
| Rate for Payer: Humana Commercial |
$70,473.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,986.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,187.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,872.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,960.76
|
| Rate for Payer: Ohio Health Group HMO |
$62,182.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,327.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72,131.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,207.87
|
| Rate for Payer: PHCS Commercial |
$79,593.55
|
| Rate for Payer: United Healthcare All Payer |
$72,960.76
|
|
|
EOSINOPHIL STOOL/URINE
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
30001326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
EOSINOPHIL STOOL/URINE
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
30001326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
EOVIST.25MMOL/1ML 2.5MMOL/10ML
|
Facility
|
IP
|
$180.46
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
25001804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.14 |
| Max. Negotiated Rate |
$173.24 |
| Rate for Payer: Aetna Commercial |
$138.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.76
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Cigna Commercial |
$149.78
|
| Rate for Payer: First Health Commercial |
$171.44
|
| Rate for Payer: Humana Commercial |
$153.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.80
|
| Rate for Payer: Ohio Health Group HMO |
$135.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.52
|
| Rate for Payer: PHCS Commercial |
$173.24
|
| Rate for Payer: United Healthcare All Payer |
$158.80
|
|
|
EOVIST.25MMOL/1ML 2.5MMOL/10ML
|
Facility
|
OP
|
$180.46
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
25001804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.14 |
| Max. Negotiated Rate |
$173.24 |
| Rate for Payer: Aetna Commercial |
$138.95
|
| Rate for Payer: Anthem Medicaid |
$62.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.76
|
| Rate for Payer: Cash Price |
$90.23
|
| Rate for Payer: Cigna Commercial |
$149.78
|
| Rate for Payer: First Health Commercial |
$171.44
|
| Rate for Payer: Humana Commercial |
$153.39
|
| Rate for Payer: Humana KY Medicaid |
$62.06
|
| Rate for Payer: Kentucky WC Medicaid |
$62.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.80
|
| Rate for Payer: Ohio Health Group HMO |
$135.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.52
|
| Rate for Payer: PHCS Commercial |
$173.24
|
| Rate for Payer: United Healthcare All Payer |
$158.80
|
|
|
EPHEDRINE 50 MG/1 ML
|
Facility
|
IP
|
$203.29
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
25003044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.99 |
| 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 |
$162.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.27
|
| 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 |
$60.99 |
| 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 |
$162.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.27
|
| Rate for Payer: PHCS Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Payer |
$178.90
|
|
|
EPHEDRINE 5MG/ML 10ML SYRINGE
|
Facility
|
OP
|
$203.29
|
|
|
Service Code
|
NDC 65219025700
|
| Hospital Charge Code |
25003045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.99 |
| 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 |
$162.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.27
|
| 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 |
$60.99 |
| 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 |
$162.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.27
|
| Rate for Payer: PHCS Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Payer |
$178.90
|
|
|
EPIC STENT 120CM 10*30
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
EPIC STENT 120CM 10*30
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
EPIC STENT 120CM 10*40
|
Facility
|
IP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
EPIC STENT 120CM 10*40
|
Facility
|
OP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem Medicaid |
$2,443.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Humana KY Medicaid |
$2,443.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
EPIC STENT 120CM 10*50
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
EPIC STENT 120CM 10*50
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
EPIC STENT 120CM 12*30
|
Facility
|
IP
|
$4,193.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.12 |
| Max. Negotiated Rate |
$4,026.00 |
| Rate for Payer: Aetna Commercial |
$3,229.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,271.12
|
| Rate for Payer: Cash Price |
$2,096.88
|
| Rate for Payer: Cigna Commercial |
$3,480.81
|
| Rate for Payer: First Health Commercial |
$3,984.06
|
| Rate for Payer: Humana Commercial |
$3,564.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,438.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,094.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,690.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,145.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.69
|
| Rate for Payer: PHCS Commercial |
$4,026.00
|
| Rate for Payer: United Healthcare All Payer |
$3,690.50
|
|
|
EPIC STENT 120CM 12*30
|
Facility
|
OP
|
$4,193.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.12 |
| Max. Negotiated Rate |
$4,026.00 |
| Rate for Payer: Aetna Commercial |
$3,229.19
|
| Rate for Payer: Anthem Medicaid |
$1,442.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,271.12
|
| Rate for Payer: Cash Price |
$2,096.88
|
| Rate for Payer: Cigna Commercial |
$3,480.81
|
| Rate for Payer: First Health Commercial |
$3,984.06
|
| Rate for Payer: Humana Commercial |
$3,564.69
|
| Rate for Payer: Humana KY Medicaid |
$1,442.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,456.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,438.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,094.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,690.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,145.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.69
|
| Rate for Payer: PHCS Commercial |
$4,026.00
|
| Rate for Payer: United Healthcare All Payer |
$3,690.50
|
|
|
EPIC STENT 120CM 12*40
|
Facility
|
OP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem Medicaid |
$2,443.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Humana KY Medicaid |
$2,443.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
EPIC STENT 120CM 12*40
|
Facility
|
IP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
EPIC STENT 120CM 12*50
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
EPIC STENT 120CM 12*50
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
EPIC STENT 120CM 6*100
|
Facility
|
OP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem Medicaid |
$1,751.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Humana KY Medicaid |
$1,751.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,786.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
EPIC STENT 120CM 6*100
|
Facility
|
IP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
EPIC STENT 120CM 6*120
|
Facility
|
IP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
EPIC STENT 120CM 6*120
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
