|
EXPRESS STENT 10*57
|
Facility
|
IP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
|
EXPRESS STENT 5*19 150CM
|
Facility
|
OP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem Medicaid |
$2,451.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Humana KY Medicaid |
$2,451.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 5*19 150CM
|
Facility
|
IP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 5*19*90
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS STENT 5*19*90
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS STENT 6*14 150CM
|
Facility
|
OP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem Medicaid |
$2,451.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Humana KY Medicaid |
$2,451.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 6*14 150CM
|
Facility
|
IP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 6*18 150CM
|
Facility
|
OP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem Medicaid |
$2,451.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Humana KY Medicaid |
$2,451.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 6*18 150CM
|
Facility
|
IP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 6*27*135
|
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
|
|
|
EXPRESS STENT 6*27*135
|
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
|
|
|
EXPRESS STENT 7*15 150CM
|
Facility
|
IP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 7*15 150CM
|
Facility
|
OP
|
$7,127.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.64 |
| Max. Negotiated Rate |
$6,842.87 |
| Rate for Payer: Aetna Commercial |
$5,488.55
|
| Rate for Payer: Anthem Medicaid |
$2,451.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,559.83
|
| Rate for Payer: Cash Price |
$3,563.99
|
| Rate for Payer: Cigna Commercial |
$5,916.23
|
| Rate for Payer: First Health Commercial |
$6,771.59
|
| Rate for Payer: Humana Commercial |
$6,058.79
|
| Rate for Payer: Humana KY Medicaid |
$2,451.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,844.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,345.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.68
|
| Rate for Payer: PHCS Commercial |
$6,842.87
|
| Rate for Payer: United Healthcare All Payer |
$6,272.63
|
|
|
EXPRESS STENT 7*19 150CM
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS STENT 7*19 150CM
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS STENT 7*27*137
|
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
|
|
|
EXPRESS STENT 7*27*137
|
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
|
|
|
EXPRESS STENT 8*27*135
|
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
|
|
|
EXPRESS STENT 8*27*135
|
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
|
|
|
EXPRESS STENT 8*37*135
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS STENT 8*37*135
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS STENT 9*37
|
Facility
|
OP
|
$5,346.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.04 |
| Max. Negotiated Rate |
$5,132.64 |
| Rate for Payer: Aetna Commercial |
$4,116.80
|
| Rate for Payer: Anthem Medicaid |
$1,838.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,170.27
|
| Rate for Payer: Cash Price |
$2,673.25
|
| Rate for Payer: Cigna Commercial |
$4,437.60
|
| Rate for Payer: First Health Commercial |
$5,079.18
|
| Rate for Payer: Humana Commercial |
$4,544.52
|
| Rate for Payer: Humana KY Medicaid |
$1,838.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,857.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,384.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,945.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,603.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,875.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,704.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,009.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,069.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,657.42
|
| Rate for Payer: PHCS Commercial |
$5,132.64
|
| Rate for Payer: United Healthcare All Payer |
$4,704.92
|
|
|
EXPRESS STENT 9*37
|
Facility
|
IP
|
$5,346.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.04 |
| Max. Negotiated Rate |
$5,132.64 |
| Rate for Payer: Aetna Commercial |
$4,116.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,170.27
|
| Rate for Payer: Cash Price |
$2,673.25
|
| Rate for Payer: Cigna Commercial |
$4,437.60
|
| Rate for Payer: First Health Commercial |
$5,079.18
|
| Rate for Payer: Humana Commercial |
$4,544.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,384.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,945.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,603.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,704.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,009.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,069.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,657.42
|
| Rate for Payer: PHCS Commercial |
$5,132.64
|
| Rate for Payer: United Healthcare All Payer |
$4,704.92
|
|
|
EXPRESS STENT 9*57
|
Facility
|
OP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem Medicaid |
$2,651.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Humana KY Medicaid |
$2,651.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,678.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
|
EXPRESS STENT 9*57
|
Facility
|
IP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
