|
STENT 15MM ON 6MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 15MM ON 6MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 5MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 5MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 6MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 6MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 29MM ON 7MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 29MM ON 7MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 29MM ON 8MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 29MM ON 8MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 39MM ON 7MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 39MM ON 7MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 39MM ON 8MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 39MM ON 8MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT AAA BFR 13.5CM 24MM*14MM
|
Facility
|
IP
|
$31,262.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.12 |
| Max. Negotiated Rate |
$30,012.00 |
| Rate for Payer: Aetna Commercial |
$24,072.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,384.75
|
| Rate for Payer: Cash Price |
$15,631.25
|
| Rate for Payer: Cigna Commercial |
$25,947.88
|
| Rate for Payer: First Health Commercial |
$29,699.38
|
| Rate for Payer: Humana Commercial |
$26,573.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,635.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,071.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,378.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,511.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,446.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,252.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,064.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,691.38
|
| Rate for Payer: PHCS Commercial |
$30,012.00
|
| Rate for Payer: United Healthcare All Payer |
$27,511.00
|
|
|
STENT AAA BFR 13.5CM 24MM*14MM
|
Facility
|
OP
|
$31,262.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.12 |
| Max. Negotiated Rate |
$30,012.00 |
| Rate for Payer: Aetna Commercial |
$24,072.12
|
| Rate for Payer: Anthem Medicaid |
$10,751.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,384.75
|
| Rate for Payer: Cash Price |
$15,631.25
|
| Rate for Payer: Cigna Commercial |
$25,947.88
|
| Rate for Payer: First Health Commercial |
$29,699.38
|
| Rate for Payer: Humana Commercial |
$26,573.12
|
| Rate for Payer: Humana KY Medicaid |
$10,751.17
|
| Rate for Payer: Kentucky WC Medicaid |
$10,860.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,635.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,071.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,378.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,966.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,511.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,446.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,252.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,064.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,691.38
|
| Rate for Payer: PHCS Commercial |
$30,012.00
|
| Rate for Payer: United Healthcare All Payer |
$27,511.00
|
|
|
STENT AAA BFR 13.5CM 28MM*16MM
|
Facility
|
IP
|
$31,262.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.12 |
| Max. Negotiated Rate |
$30,012.00 |
| Rate for Payer: Aetna Commercial |
$24,072.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,384.75
|
| Rate for Payer: Cash Price |
$15,631.25
|
| Rate for Payer: Cigna Commercial |
$25,947.88
|
| Rate for Payer: First Health Commercial |
$29,699.38
|
| Rate for Payer: Humana Commercial |
$26,573.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,635.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,071.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,378.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,511.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,446.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,252.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,064.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,691.38
|
| Rate for Payer: PHCS Commercial |
$30,012.00
|
| Rate for Payer: United Healthcare All Payer |
$27,511.00
|
|
|
STENT AAA BFR 13.5CM 28MM*16MM
|
Facility
|
OP
|
$31,262.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.12 |
| Max. Negotiated Rate |
$30,012.00 |
| Rate for Payer: Aetna Commercial |
$24,072.12
|
| Rate for Payer: Anthem Medicaid |
$10,751.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,384.75
|
| Rate for Payer: Cash Price |
$15,631.25
|
| Rate for Payer: Cigna Commercial |
$25,947.88
|
| Rate for Payer: First Health Commercial |
$29,699.38
|
| Rate for Payer: Humana Commercial |
$26,573.12
|
| Rate for Payer: Humana KY Medicaid |
$10,751.17
|
| Rate for Payer: Kentucky WC Medicaid |
$10,860.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,635.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,071.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,378.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,966.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,511.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,446.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,252.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,064.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,691.38
|
| Rate for Payer: PHCS Commercial |
$30,012.00
|
| Rate for Payer: United Healthcare All Payer |
$27,511.00
|
|
|
STENT AAA BFR 16.5CM 24MM*14MM
|
Facility
|
IP
|
$32,357.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.48 |
| Max. Negotiated Rate |
$31,063.20 |
| Rate for Payer: Aetna Commercial |
$24,915.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,238.85
|
| Rate for Payer: Cash Price |
$16,178.75
|
| Rate for Payer: Cigna Commercial |
$26,856.72
|
| Rate for Payer: First Health Commercial |
$30,739.62
|
| Rate for Payer: Humana Commercial |
$27,503.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,533.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,879.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,474.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,268.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,030.82
|
| Rate for Payer: PHCS Commercial |
$31,063.20
|
| Rate for Payer: United Healthcare All Payer |
$28,474.60
|
|
|
STENT AAA BFR 16.5CM 24MM*14MM
|
Facility
|
OP
|
$32,357.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.48 |
| Max. Negotiated Rate |
$31,063.20 |
| Rate for Payer: Aetna Commercial |
$24,915.28
|
| Rate for Payer: Anthem Medicaid |
$11,127.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,238.85
|
| Rate for Payer: Cash Price |
$16,178.75
|
| Rate for Payer: Cigna Commercial |
$26,856.72
|
| Rate for Payer: First Health Commercial |
$30,739.62
|
| Rate for Payer: Humana Commercial |
$27,503.88
|
| Rate for Payer: Humana KY Medicaid |
$11,127.74
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,533.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,879.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,474.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,268.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,030.82
|
| Rate for Payer: PHCS Commercial |
$31,063.20
|
| Rate for Payer: United Healthcare All Payer |
$28,474.60
|
|
|
STENT AAA BFR 16.5CM 28MM*16MM
|
Facility
|
OP
|
$32,357.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.48 |
| Max. Negotiated Rate |
$31,063.20 |
| Rate for Payer: Aetna Commercial |
$24,915.28
|
| Rate for Payer: Anthem Medicaid |
$11,127.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,238.85
|
| Rate for Payer: Cash Price |
$16,178.75
|
| Rate for Payer: Cigna Commercial |
$26,856.72
|
| Rate for Payer: First Health Commercial |
$30,739.62
|
| Rate for Payer: Humana Commercial |
$27,503.88
|
| Rate for Payer: Humana KY Medicaid |
$11,127.74
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,533.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,879.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,474.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,268.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,030.82
|
| Rate for Payer: PHCS Commercial |
$31,063.20
|
| Rate for Payer: United Healthcare All Payer |
$28,474.60
|
|
|
STENT AAA BFR 16.5CM 28MM*16MM
|
Facility
|
IP
|
$32,357.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.48 |
| Max. Negotiated Rate |
$31,063.20 |
| Rate for Payer: Aetna Commercial |
$24,915.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,238.85
|
| Rate for Payer: Cash Price |
$16,178.75
|
| Rate for Payer: Cigna Commercial |
$26,856.72
|
| Rate for Payer: First Health Commercial |
$30,739.62
|
| Rate for Payer: Humana Commercial |
$27,503.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,533.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,879.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,474.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,268.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,030.82
|
| Rate for Payer: PHCS Commercial |
$31,063.20
|
| Rate for Payer: United Healthcare All Payer |
$28,474.60
|
|
|
STENT AAA EXT ILIAC 12*7 GORE
|
Facility
|
IP
|
$11,545.35
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.90 |
| Max. Negotiated Rate |
$11,083.54 |
| Rate for Payer: Aetna Commercial |
$8,889.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,005.37
|
| Rate for Payer: Cash Price |
$5,772.68
|
| Rate for Payer: Cigna Commercial |
$9,582.64
|
| Rate for Payer: First Health Commercial |
$10,968.08
|
| Rate for Payer: Humana Commercial |
$9,813.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,467.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,520.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,463.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,159.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,659.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,309.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.06
|
| Rate for Payer: PHCS Commercial |
$11,083.54
|
| Rate for Payer: United Healthcare All Payer |
$10,159.91
|
|
