|
EXPNDR MED HGT CPX3 TISS 450CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 550CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 550CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 650CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 650CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 800CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 800CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPORT ASPIRATION CATH 6FR
|
Facility
|
IP
|
$3,443.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.12 |
| Max. Negotiated Rate |
$3,306.00 |
| Rate for Payer: Aetna Commercial |
$2,651.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,686.12
|
| Rate for Payer: Cash Price |
$1,721.88
|
| Rate for Payer: Cigna Commercial |
$2,858.31
|
| Rate for Payer: First Health Commercial |
$3,271.56
|
| Rate for Payer: Humana Commercial |
$2,927.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,823.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,541.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,030.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,582.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.19
|
| Rate for Payer: PHCS Commercial |
$3,306.00
|
| Rate for Payer: United Healthcare All Payer |
$3,030.50
|
|
|
EXPORT ASPIRATION CATH 6FR
|
Facility
|
OP
|
$3,443.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.12 |
| Max. Negotiated Rate |
$3,306.00 |
| Rate for Payer: Aetna Commercial |
$2,651.69
|
| Rate for Payer: Anthem Medicaid |
$1,184.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,686.12
|
| Rate for Payer: Cash Price |
$1,721.88
|
| Rate for Payer: Cigna Commercial |
$2,858.31
|
| Rate for Payer: First Health Commercial |
$3,271.56
|
| Rate for Payer: Humana Commercial |
$2,927.19
|
| Rate for Payer: Humana KY Medicaid |
$1,184.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,196.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,823.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,541.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,208.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,030.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,582.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.19
|
| Rate for Payer: PHCS Commercial |
$3,306.00
|
| Rate for Payer: United Healthcare All Payer |
$3,030.50
|
|
|
EXPRESS SD 5*15
|
Facility
|
OP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem Medicaid |
$2,607.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Humana KY Medicaid |
$2,607.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,634.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,659.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
EXPRESS SD 5*15
|
Facility
|
IP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
EXPRESS SHUNT MINI POST FLOW
|
Facility
|
IP
|
$6,927.73
|
|
|
Service Code
|
HCPCS L8612
|
| Hospital Charge Code |
27000189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.32 |
| Max. Negotiated Rate |
$6,650.62 |
| Rate for Payer: Aetna Commercial |
$5,334.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,403.63
|
| Rate for Payer: Cash Price |
$3,463.86
|
| Rate for Payer: Cigna Commercial |
$5,750.02
|
| Rate for Payer: First Health Commercial |
$6,581.34
|
| Rate for Payer: Humana Commercial |
$5,888.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,680.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,112.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,195.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,542.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,027.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,780.13
|
| Rate for Payer: PHCS Commercial |
$6,650.62
|
| Rate for Payer: United Healthcare All Payer |
$6,096.40
|
|
|
EXPRESS SHUNT MINI POST FLOW
|
Facility
|
OP
|
$6,927.73
|
|
|
Service Code
|
HCPCS L8612
|
| Hospital Charge Code |
27000189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.32 |
| Max. Negotiated Rate |
$6,650.62 |
| Rate for Payer: Aetna Commercial |
$5,334.35
|
| Rate for Payer: Anthem Medicaid |
$2,382.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,403.63
|
| Rate for Payer: Cash Price |
$3,463.86
|
| Rate for Payer: Cigna Commercial |
$5,750.02
|
| Rate for Payer: First Health Commercial |
$6,581.34
|
| Rate for Payer: Humana Commercial |
$5,888.57
|
| Rate for Payer: Humana KY Medicaid |
$2,382.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,406.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,680.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,112.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,430.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,195.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,542.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,027.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,780.13
|
| Rate for Payer: PHCS Commercial |
$6,650.62
|
| Rate for Payer: United Healthcare All Payer |
$6,096.40
|
|
|
EXPRESS STENT 10*57
|
Facility
|
IP
|
$7,911.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.32 |
| Max. Negotiated Rate |
$7,594.64 |
| Rate for Payer: Aetna Commercial |
$6,091.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,170.64
|
| Rate for Payer: Cash Price |
$3,955.54
|
| Rate for Payer: Cigna Commercial |
$6,566.20
|
| Rate for Payer: First Health Commercial |
$7,515.53
|
| Rate for Payer: Humana Commercial |
$6,724.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,487.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,838.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,961.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.65
|
| Rate for Payer: PHCS Commercial |
$7,594.64
|
| Rate for Payer: United Healthcare All Payer |
$6,961.75
|
|
|
EXPRESS STENT 10*57
|
Facility
|
OP
|
$7,911.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.32 |
| Max. Negotiated Rate |
$7,594.64 |
| Rate for Payer: Aetna Commercial |
$6,091.53
|
| Rate for Payer: Anthem Medicaid |
$2,720.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,170.64
|
| Rate for Payer: Cash Price |
$3,955.54
|
| Rate for Payer: Cigna Commercial |
$6,566.20
|
| Rate for Payer: First Health Commercial |
$7,515.53
|
| Rate for Payer: Humana Commercial |
$6,724.42
|
| Rate for Payer: Humana KY Medicaid |
$2,720.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,748.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,487.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,838.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,961.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.65
|
| Rate for Payer: PHCS Commercial |
$7,594.64
|
| Rate for Payer: United Healthcare All Payer |
$6,961.75
|
|
|
EXPRESS STENT 5*19 150CM
|
Facility
|
OP
|
$7,327.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.40 |
| Max. Negotiated Rate |
$7,034.87 |
| Rate for Payer: Aetna Commercial |
$5,642.55
|
| Rate for Payer: Anthem Medicaid |
$2,520.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,715.83
|
| Rate for Payer: Cash Price |
$3,663.99
|
| Rate for Payer: Cigna Commercial |
$6,082.23
|
| Rate for Payer: First Health Commercial |
$6,961.59
|
| Rate for Payer: Humana Commercial |
$6,228.79
|
| Rate for Payer: Humana KY Medicaid |
$2,520.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,008.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,570.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,495.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.31
|
| Rate for Payer: PHCS Commercial |
$7,034.87
|
| Rate for Payer: United Healthcare All Payer |
$6,448.63
|
|
|
EXPRESS STENT 5*19 150CM
|
Facility
|
IP
|
$7,327.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.40 |
| Max. Negotiated Rate |
$7,034.87 |
| Rate for Payer: Aetna Commercial |
$5,642.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,715.83
|
| Rate for Payer: Cash Price |
$3,663.99
|
| Rate for Payer: Cigna Commercial |
$6,082.23
|
| Rate for Payer: First Health Commercial |
$6,961.59
|
| Rate for Payer: Humana Commercial |
$6,228.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,008.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,495.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.31
|
| Rate for Payer: PHCS Commercial |
$7,034.87
|
| Rate for Payer: United Healthcare All Payer |
$6,448.63
|
|
|
EXPRESS STENT 5*19*90
|
Facility
|
IP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
EXPRESS STENT 5*19*90
|
Facility
|
OP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem Medicaid |
$2,607.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Humana KY Medicaid |
$2,607.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,634.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,659.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
EXPRESS STENT 6*14 150CM
|
Facility
|
IP
|
$7,327.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.40 |
| Max. Negotiated Rate |
$7,034.87 |
| Rate for Payer: Aetna Commercial |
$5,642.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,715.83
|
| Rate for Payer: Cash Price |
$3,663.99
|
| Rate for Payer: Cigna Commercial |
$6,082.23
|
| Rate for Payer: First Health Commercial |
$6,961.59
|
| Rate for Payer: Humana Commercial |
$6,228.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,008.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,495.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.31
|
| Rate for Payer: PHCS Commercial |
$7,034.87
|
| Rate for Payer: United Healthcare All Payer |
$6,448.63
|
|
|
EXPRESS STENT 6*14 150CM
|
Facility
|
OP
|
$7,327.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.40 |
| Max. Negotiated Rate |
$7,034.87 |
| Rate for Payer: Aetna Commercial |
$5,642.55
|
| Rate for Payer: Anthem Medicaid |
$2,520.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,715.83
|
| Rate for Payer: Cash Price |
$3,663.99
|
| Rate for Payer: Cigna Commercial |
$6,082.23
|
| Rate for Payer: First Health Commercial |
$6,961.59
|
| Rate for Payer: Humana Commercial |
$6,228.79
|
| Rate for Payer: Humana KY Medicaid |
$2,520.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,008.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,570.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,495.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.31
|
| Rate for Payer: PHCS Commercial |
$7,034.87
|
| Rate for Payer: United Healthcare All Payer |
$6,448.63
|
|
|
EXPRESS STENT 6*18 150CM
|
Facility
|
IP
|
$7,327.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.40 |
| Max. Negotiated Rate |
$7,034.87 |
| Rate for Payer: Aetna Commercial |
$5,642.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,715.83
|
| Rate for Payer: Cash Price |
$3,663.99
|
| Rate for Payer: Cigna Commercial |
$6,082.23
|
| Rate for Payer: First Health Commercial |
$6,961.59
|
| Rate for Payer: Humana Commercial |
$6,228.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,008.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,495.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.31
|
| Rate for Payer: PHCS Commercial |
$7,034.87
|
| Rate for Payer: United Healthcare All Payer |
$6,448.63
|
|
|
EXPRESS STENT 6*18 150CM
|
Facility
|
OP
|
$7,327.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.40 |
| Max. Negotiated Rate |
$7,034.87 |
| Rate for Payer: Aetna Commercial |
$5,642.55
|
| Rate for Payer: Anthem Medicaid |
$2,520.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,715.83
|
| Rate for Payer: Cash Price |
$3,663.99
|
| Rate for Payer: Cigna Commercial |
$6,082.23
|
| Rate for Payer: First Health Commercial |
$6,961.59
|
| Rate for Payer: Humana Commercial |
$6,228.79
|
| Rate for Payer: Humana KY Medicaid |
$2,520.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,008.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,570.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,495.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.31
|
| Rate for Payer: PHCS Commercial |
$7,034.87
|
| Rate for Payer: United Healthcare All Payer |
$6,448.63
|
|
|
EXPRESS STENT 6*27*135
|
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
|
|
|
EXPRESS STENT 6*27*135
|
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
|
|
