|
EXPRESS STENT LD 10*25*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 LD 10*25*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 LD 10*37*135
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 10*37*135
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 135CM 7*37
|
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 LD 135CM 7*37
|
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 LD 73CM 9*37
|
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 LD 73CM 9*37
|
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 LD 7MM*17MM
|
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 LD 7MM*17MM
|
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 LD 7MM*27MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 7MM*27MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 7MM*57MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 7MM*57MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 8*17*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 LD 8*17*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 LD 8MM*27MM
|
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 LD 8MM*27MM
|
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 LD 8MM*37MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 8MM*37MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
EXPRESS STENT LD 9*25*135
|
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 LD 9*25*135
|
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 SD 4*15*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 SD 4*15*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 SD 4*19*150
|
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
|
|
