|
STENT AAA EXT ILIAC 12*7 GORE
|
Facility
|
OP
|
$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 Medicaid |
$3,970.45
|
| 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: Humana KY Medicaid |
$3,970.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,010.85
|
| 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: Molina Healthcare Medicaid |
$4,050.11
|
| 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
|
|
|
STENT AAA EXT ILIAC 14.5*7 GOR
|
Facility
|
OP
|
$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 Medicaid |
$3,970.45
|
| 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: Humana KY Medicaid |
$3,970.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,010.85
|
| 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: Molina Healthcare Medicaid |
$4,050.11
|
| 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
|
|
|
STENT AAA EXT ILIAC 14.5*7 GOR
|
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
|
|
|
STENT AAA ILIAC LMB 11.5CM*14M
|
Facility
|
IP
|
$12,151.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.66 |
| Max. Negotiated Rate |
$11,665.20 |
| Rate for Payer: Aetna Commercial |
$9,356.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,477.98
|
| Rate for Payer: Cash Price |
$6,075.62
|
| Rate for Payer: Cigna Commercial |
$10,085.54
|
| Rate for Payer: First Health Commercial |
$11,543.69
|
| Rate for Payer: Humana Commercial |
$10,328.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,964.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,967.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,645.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,693.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,113.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,766.89
|
| Rate for Payer: PHCS Commercial |
$11,665.20
|
| Rate for Payer: United Healthcare All Payer |
$10,693.10
|
|
|
STENT AAA ILIAC LMB 11.5CM*14M
|
Facility
|
OP
|
$12,151.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.66 |
| Max. Negotiated Rate |
$11,665.20 |
| Rate for Payer: Aetna Commercial |
$9,356.46
|
| Rate for Payer: Anthem Medicaid |
$4,178.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,477.98
|
| Rate for Payer: Cash Price |
$6,075.62
|
| Rate for Payer: Cigna Commercial |
$10,085.54
|
| Rate for Payer: First Health Commercial |
$11,543.69
|
| Rate for Payer: Humana Commercial |
$10,328.56
|
| Rate for Payer: Humana KY Medicaid |
$4,178.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,221.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,964.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,967.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,645.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,693.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,113.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,766.89
|
| Rate for Payer: PHCS Commercial |
$11,665.20
|
| Rate for Payer: United Healthcare All Payer |
$10,693.10
|
|
|
STENT AAA ILIAC LMB 11.5CM*16M
|
Facility
|
IP
|
$12,151.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.66 |
| Max. Negotiated Rate |
$11,665.20 |
| Rate for Payer: Aetna Commercial |
$9,356.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,477.98
|
| Rate for Payer: Cash Price |
$6,075.62
|
| Rate for Payer: Cigna Commercial |
$10,085.54
|
| Rate for Payer: First Health Commercial |
$11,543.69
|
| Rate for Payer: Humana Commercial |
$10,328.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,964.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,967.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,645.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,693.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,113.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,766.89
|
| Rate for Payer: PHCS Commercial |
$11,665.20
|
| Rate for Payer: United Healthcare All Payer |
$10,693.10
|
|
|
STENT AAA ILIAC LMB 11.5CM*16M
|
Facility
|
OP
|
$12,151.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.66 |
| Max. Negotiated Rate |
$11,665.20 |
| Rate for Payer: Aetna Commercial |
$9,356.46
|
| Rate for Payer: Anthem Medicaid |
$4,178.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,477.98
|
| Rate for Payer: Cash Price |
$6,075.62
|
| Rate for Payer: Cigna Commercial |
$10,085.54
|
| Rate for Payer: First Health Commercial |
$11,543.69
|
| Rate for Payer: Humana Commercial |
$10,328.56
|
| Rate for Payer: Humana KY Medicaid |
$4,178.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,221.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,964.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,967.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,645.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,693.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,113.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,766.89
|
| Rate for Payer: PHCS Commercial |
$11,665.20
|
| Rate for Payer: United Healthcare All Payer |
$10,693.10
|
|
|
STENT AAA ILIAC LMB 8.5CM*14MM
|
Facility
|
OP
|
$11,421.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,484.76 |
| Max. Negotiated Rate |
$10,964.40 |
| Rate for Payer: Aetna Commercial |
$8,794.36
|
| Rate for Payer: Anthem Medicaid |
$3,927.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,908.58
|
| Rate for Payer: Cash Price |
$5,710.62
|
| Rate for Payer: Cigna Commercial |
$9,479.64
|
| Rate for Payer: First Health Commercial |
$10,850.19
|
| Rate for Payer: Humana Commercial |
$9,708.06
|
| Rate for Payer: Humana KY Medicaid |
$3,927.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,967.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,365.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,428.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,426.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,006.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,050.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,565.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,540.59
|
| Rate for Payer: PHCS Commercial |
$10,964.40
|
| Rate for Payer: United Healthcare All Payer |
$10,050.70
|
|
|
STENT AAA ILIAC LMB 8.5CM*14MM
|
Facility
|
IP
|
$11,421.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,484.76 |
| Max. Negotiated Rate |
$10,964.40 |
| Rate for Payer: Aetna Commercial |
$8,794.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,908.58
|
| Rate for Payer: Cash Price |
$5,710.62
|
| Rate for Payer: Cigna Commercial |
$9,479.64
|
| Rate for Payer: First Health Commercial |
$10,850.19
|
| Rate for Payer: Humana Commercial |
$9,708.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,365.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,428.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,426.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,050.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,565.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,540.59
|
| Rate for Payer: PHCS Commercial |
$10,964.40
|
| Rate for Payer: United Healthcare All Payer |
$10,050.70
|
|
|
STENT AAA ILIAC LMB 8.5CM*16MM
|
Facility
|
IP
|
$11,421.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,484.76 |
| Max. Negotiated Rate |
$10,964.40 |
| Rate for Payer: Aetna Commercial |
$8,794.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,908.58
|
| Rate for Payer: Cash Price |
$5,710.62
|
| Rate for Payer: Cigna Commercial |
$9,479.64
|
| Rate for Payer: First Health Commercial |
$10,850.19
|
| Rate for Payer: Humana Commercial |
$9,708.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,365.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,428.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,426.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,050.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,565.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,540.59
|
| Rate for Payer: PHCS Commercial |
$10,964.40
|
| Rate for Payer: United Healthcare All Payer |
$10,050.70
|
|
|
STENT AAA ILIAC LMB 8.5CM*16MM
|
Facility
|
OP
|
$11,421.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,484.76 |
| Max. Negotiated Rate |
$10,964.40 |
| Rate for Payer: Aetna Commercial |
$8,794.36
|
| Rate for Payer: Anthem Medicaid |
$3,927.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,908.58
|
| Rate for Payer: Cash Price |
$5,710.62
|
| Rate for Payer: Cigna Commercial |
$9,479.64
|
| Rate for Payer: First Health Commercial |
$10,850.19
|
| Rate for Payer: Humana Commercial |
$9,708.06
|
| Rate for Payer: Humana KY Medicaid |
$3,927.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,967.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,365.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,428.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,426.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,006.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,050.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,565.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,484.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,540.59
|
| Rate for Payer: PHCS Commercial |
$10,964.40
|
| Rate for Payer: United Healthcare All Payer |
$10,050.70
|
|
|
STENT AORTCEXT CUFF 3.75CM*22M
|
Facility
|
IP
|
$10,691.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.86 |
| Max. Negotiated Rate |
$10,263.60 |
| Rate for Payer: Aetna Commercial |
$8,232.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,339.18
|
| Rate for Payer: Cash Price |
$5,345.62
|
| Rate for Payer: Cigna Commercial |
$8,873.74
|
| Rate for Payer: First Health Commercial |
$10,156.69
|
| Rate for Payer: Humana Commercial |
$9,087.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,766.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,890.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,207.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,408.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,018.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.29
|
| Rate for Payer: PHCS Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Payer |
$9,408.30
|
|
|
STENT AORTCEXT CUFF 3.75CM*22M
|
Facility
|
OP
|
$10,691.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.86 |
| Max. Negotiated Rate |
$10,263.60 |
| Rate for Payer: Aetna Commercial |
$8,232.26
|
| Rate for Payer: Anthem Medicaid |
$3,676.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,339.18
|
| Rate for Payer: Cash Price |
$5,345.62
|
| Rate for Payer: Cigna Commercial |
$8,873.74
|
| Rate for Payer: First Health Commercial |
$10,156.69
|
| Rate for Payer: Humana Commercial |
$9,087.56
|
| Rate for Payer: Humana KY Medicaid |
$3,676.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,714.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,766.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,890.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,207.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,750.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,408.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,018.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.29
|
| Rate for Payer: PHCS Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Payer |
$9,408.30
|
|
|
STENT AORTCEXT CUFF 3.75CM*24M
|
Facility
|
IP
|
$10,691.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.86 |
| Max. Negotiated Rate |
$10,263.60 |
| Rate for Payer: Aetna Commercial |
$8,232.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,339.18
|
| Rate for Payer: Cash Price |
$5,345.62
|
| Rate for Payer: Cigna Commercial |
$8,873.74
|
| Rate for Payer: First Health Commercial |
$10,156.69
|
| Rate for Payer: Humana Commercial |
$9,087.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,766.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,890.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,207.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,408.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,018.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.29
|
| Rate for Payer: PHCS Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Payer |
$9,408.30
|
|
|
STENT AORTCEXT CUFF 3.75CM*24M
|
Facility
|
OP
|
$10,691.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.86 |
| Max. Negotiated Rate |
$10,263.60 |
| Rate for Payer: Aetna Commercial |
$8,232.26
|
| Rate for Payer: Anthem Medicaid |
$3,676.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,339.18
|
| Rate for Payer: Cash Price |
$5,345.62
|
| Rate for Payer: Cigna Commercial |
$8,873.74
|
| Rate for Payer: First Health Commercial |
$10,156.69
|
| Rate for Payer: Humana Commercial |
$9,087.56
|
| Rate for Payer: Humana KY Medicaid |
$3,676.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,714.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,766.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,890.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,207.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,750.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,408.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,018.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.29
|
| Rate for Payer: PHCS Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Payer |
$9,408.30
|
|
|
STENT AORTCEXT CUFF 3.75CM*28M
|
Facility
|
IP
|
$10,691.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.86 |
| Max. Negotiated Rate |
$10,263.60 |
| Rate for Payer: Aetna Commercial |
$8,232.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,339.18
|
| Rate for Payer: Cash Price |
$5,345.62
|
| Rate for Payer: Cigna Commercial |
$8,873.74
|
| Rate for Payer: First Health Commercial |
$10,156.69
|
| Rate for Payer: Humana Commercial |
$9,087.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,766.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,890.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,207.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,408.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,018.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.29
|
| Rate for Payer: PHCS Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Payer |
$9,408.30
|
|
|
STENT AORTCEXT CUFF 3.75CM*28M
|
Facility
|
OP
|
$10,691.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.86 |
| Max. Negotiated Rate |
$10,263.60 |
| Rate for Payer: Aetna Commercial |
$8,232.26
|
| Rate for Payer: Anthem Medicaid |
$3,676.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,339.18
|
| Rate for Payer: Cash Price |
$5,345.62
|
| Rate for Payer: Cigna Commercial |
$8,873.74
|
| Rate for Payer: First Health Commercial |
$10,156.69
|
| Rate for Payer: Humana Commercial |
$9,087.56
|
| Rate for Payer: Humana KY Medicaid |
$3,676.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,714.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,766.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,890.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,207.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,750.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,408.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,018.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.29
|
| Rate for Payer: PHCS Commercial |
$10,263.60
|
| Rate for Payer: United Healthcare All Payer |
$9,408.30
|
|
|
STENT ASPIRE COV S70-06-050-D
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-06-050-D
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-06-100-D
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-06-100-D
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-07-050-D
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-07-050-D
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-07-100-D
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT ASPIRE COV S70-07-100-D
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
