|
EXPRESS STENT LD 7MM*27MM
|
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 7MM*57MM
|
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*57MM
|
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 8*17*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 LD 8*17*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
|
|
|
EXPRESS STENT LD 8MM*27MM
|
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 8MM*27MM
|
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 8MM*37MM
|
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 8MM*37MM
|
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 9*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 9*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 SD 4*15*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 SD 4*15*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 SD 4*19*150
|
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 SD 4*19*150
|
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 SD 6*14
|
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 SD 6*14
|
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
|
|
|
EXT. CEPHALIC VERSION
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EXT. CEPHALIC VERSION
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,283.09 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EXTENDED 4H GTR W/4 CBL 23X232
|
Facility
|
OP
|
$22,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,774.00 |
| Max. Negotiated Rate |
$21,676.80 |
| Rate for Payer: Aetna Commercial |
$17,386.60
|
| Rate for Payer: Anthem Medicaid |
$7,765.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,612.40
|
| Rate for Payer: Cash Price |
$11,290.00
|
| Rate for Payer: Cigna Commercial |
$18,741.40
|
| Rate for Payer: First Health Commercial |
$21,451.00
|
| Rate for Payer: Humana Commercial |
$19,193.00
|
| Rate for Payer: Humana KY Medicaid |
$7,765.26
|
| Rate for Payer: Kentucky WC Medicaid |
$7,844.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,515.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,664.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,774.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,921.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,870.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,935.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,644.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,580.20
|
| Rate for Payer: PHCS Commercial |
$21,676.80
|
| Rate for Payer: United Healthcare All Payer |
$19,870.40
|
|
|
EXTENDED 4H GTR W/4 CBL 23X232
|
Facility
|
IP
|
$22,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,774.00 |
| Max. Negotiated Rate |
$21,676.80 |
| Rate for Payer: Aetna Commercial |
$17,386.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,612.40
|
| Rate for Payer: Cash Price |
$11,290.00
|
| Rate for Payer: Cigna Commercial |
$18,741.40
|
| Rate for Payer: First Health Commercial |
$21,451.00
|
| Rate for Payer: Humana Commercial |
$19,193.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,515.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,664.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,774.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,870.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,935.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,644.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,580.20
|
| Rate for Payer: PHCS Commercial |
$21,676.80
|
| Rate for Payer: United Healthcare All Payer |
$19,870.40
|
|
|
EXTENDED 5H GTR W/4 CBL 23X261
|
Facility
|
IP
|
$25,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$24,355.20 |
| Rate for Payer: Aetna Commercial |
$19,534.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,788.60
|
| Rate for Payer: Cash Price |
$12,685.00
|
| Rate for Payer: Cigna Commercial |
$21,057.10
|
| Rate for Payer: First Health Commercial |
$24,101.50
|
| Rate for Payer: Humana Commercial |
$21,564.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,803.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,723.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,611.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,325.60
|
| Rate for Payer: Ohio Health Group HMO |
$19,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,071.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,505.30
|
| Rate for Payer: PHCS Commercial |
$24,355.20
|
| Rate for Payer: United Healthcare All Payer |
$22,325.60
|
|
|
EXTENDED 5H GTR W/4 CBL 23X261
|
Facility
|
OP
|
$25,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$24,355.20 |
| Rate for Payer: Aetna Commercial |
$19,534.90
|
| Rate for Payer: Anthem Medicaid |
$8,724.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,788.60
|
| Rate for Payer: Cash Price |
$12,685.00
|
| Rate for Payer: Cigna Commercial |
$21,057.10
|
| Rate for Payer: First Health Commercial |
$24,101.50
|
| Rate for Payer: Humana Commercial |
$21,564.50
|
| Rate for Payer: Humana KY Medicaid |
$8,724.74
|
| Rate for Payer: Kentucky WC Medicaid |
$8,813.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,803.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,723.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,611.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,899.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,325.60
|
| Rate for Payer: Ohio Health Group HMO |
$19,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,071.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,505.30
|
| Rate for Payer: PHCS Commercial |
$24,355.20
|
| Rate for Payer: United Healthcare All Payer |
$22,325.60
|
|
|
EXTENDER CUFF AORTIC 4CM 20MM
|
Facility
|
IP
|
$11,665.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,499.72 |
| Max. Negotiated Rate |
$11,199.12 |
| Rate for Payer: Aetna Commercial |
$8,982.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,099.28
|
| Rate for Payer: Cash Price |
$5,832.88
|
| Rate for Payer: Cigna Commercial |
$9,682.57
|
| Rate for Payer: First Health Commercial |
$11,082.46
|
| Rate for Payer: Humana Commercial |
$9,915.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,565.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,609.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,499.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,265.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,749.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,149.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,049.37
|
| Rate for Payer: PHCS Commercial |
$11,199.12
|
| Rate for Payer: United Healthcare All Payer |
$10,265.86
|
|
|
EXTENDER CUFF AORTIC 4CM 20MM
|
Facility
|
OP
|
$11,665.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,499.72 |
| Max. Negotiated Rate |
$11,199.12 |
| Rate for Payer: Aetna Commercial |
$8,982.63
|
| Rate for Payer: Anthem Medicaid |
$4,011.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,099.28
|
| Rate for Payer: Cash Price |
$5,832.88
|
| Rate for Payer: Cigna Commercial |
$9,682.57
|
| Rate for Payer: First Health Commercial |
$11,082.46
|
| Rate for Payer: Humana Commercial |
$9,915.89
|
| Rate for Payer: Humana KY Medicaid |
$4,011.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,052.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,565.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,609.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,499.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,092.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,265.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,749.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,149.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,049.37
|
| Rate for Payer: PHCS Commercial |
$11,199.12
|
| Rate for Payer: United Healthcare All Payer |
$10,265.86
|
|
