|
EXPRESS STENT 7*15 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 7*15 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 7*19 150CM
|
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 7*19 150CM
|
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 7*27*137
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
EXPRESS STENT 7*27*137
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
EXPRESS STENT 8*27*135
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
EXPRESS STENT 8*27*135
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
EXPRESS STENT 8*37*135
|
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 8*37*135
|
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 9*37
|
Facility
|
OP
|
$5,371.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,611.38 |
| Max. Negotiated Rate |
$5,156.40 |
| Rate for Payer: Aetna Commercial |
$4,135.86
|
| Rate for Payer: Anthem Medicaid |
$1,847.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,189.57
|
| Rate for Payer: Cash Price |
$2,685.62
|
| Rate for Payer: Cigna Commercial |
$4,458.14
|
| Rate for Payer: First Health Commercial |
$5,102.69
|
| Rate for Payer: Humana Commercial |
$4,565.56
|
| Rate for Payer: Humana KY Medicaid |
$1,847.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,865.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,404.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,963.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,884.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,726.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,028.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,297.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,672.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,706.16
|
| Rate for Payer: PHCS Commercial |
$5,156.40
|
| Rate for Payer: United Healthcare All Payer |
$4,726.70
|
|
|
EXPRESS STENT 9*37
|
Facility
|
IP
|
$5,371.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,611.38 |
| Max. Negotiated Rate |
$5,156.40 |
| Rate for Payer: Aetna Commercial |
$4,135.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,189.57
|
| Rate for Payer: Cash Price |
$2,685.62
|
| Rate for Payer: Cigna Commercial |
$4,458.14
|
| Rate for Payer: First Health Commercial |
$5,102.69
|
| Rate for Payer: Humana Commercial |
$4,565.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,404.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,963.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,726.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,028.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,297.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,672.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,706.16
|
| Rate for Payer: PHCS Commercial |
$5,156.40
|
| Rate for Payer: United Healthcare All Payer |
$4,726.70
|
|
|
EXPRESS STENT 9*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 9*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 LD 10*25*135
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
EXPRESS STENT LD 10*25*135
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
EXPRESS STENT LD 10*37*135
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
EXPRESS STENT LD 10*37*135
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
EXPRESS STENT LD 135CM 7*37
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
EXPRESS STENT LD 135CM 7*37
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
EXPRESS STENT LD 73CM 9*37
|
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
|
|
|
EXPRESS STENT LD 73CM 9*37
|
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 LD 7MM*17MM
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
EXPRESS STENT LD 7MM*17MM
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
EXPRESS STENT LD 7MM*27MM
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
