|
STENT ASPIRECVD 5.0 8.00 50.0L
|
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 ASPIRECVD 5.0 9.00 50.0L
|
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 ASPIRECVD 5.0 9.00 50.0L
|
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 ASPR CVD 10.0 6.00 50.0L
|
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 ASPR CVD 10.0 6.00 50.0L
|
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 ASPR CVD 10.0 7.00 50.0L
|
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 ASPR CVD 10.0 7.00 50.0L
|
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 ASPR CVD 10.0 8.00 50.0L
|
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 ASPR CVD 10.0 8.00 50.0L
|
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 BALLOON AAA GRAFT 12FR
|
Facility
|
IP
|
$3,757.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.48 |
| Max. Negotiated Rate |
$3,607.20 |
| Rate for Payer: Aetna Commercial |
$2,893.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,930.85
|
| Rate for Payer: Cash Price |
$1,878.75
|
| Rate for Payer: Cigna Commercial |
$3,118.72
|
| Rate for Payer: First Health Commercial |
$3,569.62
|
| Rate for Payer: Humana Commercial |
$3,193.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,306.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.82
|
| Rate for Payer: PHCS Commercial |
$3,607.20
|
| Rate for Payer: United Healthcare All Payer |
$3,306.60
|
|
|
STENT BALLOON AAA GRAFT 12FR
|
Facility
|
OP
|
$3,757.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.48 |
| Max. Negotiated Rate |
$3,607.20 |
| Rate for Payer: Aetna Commercial |
$2,893.28
|
| Rate for Payer: Anthem Medicaid |
$1,292.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,930.85
|
| Rate for Payer: Cash Price |
$1,878.75
|
| Rate for Payer: Cigna Commercial |
$3,118.72
|
| Rate for Payer: First Health Commercial |
$3,569.62
|
| Rate for Payer: Humana Commercial |
$3,193.88
|
| Rate for Payer: Humana KY Medicaid |
$1,292.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,305.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,318.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,306.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.82
|
| Rate for Payer: PHCS Commercial |
$3,607.20
|
| Rate for Payer: United Healthcare All Payer |
$3,306.60
|
|
|
STENT BIFUR 13.5CM 20M*12M
|
Facility
|
OP
|
$33,178.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,313.24 |
| Max. Negotiated Rate |
$31,851.60 |
| Rate for Payer: Aetna Commercial |
$25,547.64
|
| Rate for Payer: Anthem Medicaid |
$11,410.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,879.42
|
| Rate for Payer: Cash Price |
$16,589.38
|
| Rate for Payer: Cigna Commercial |
$27,538.36
|
| Rate for Payer: First Health Commercial |
$31,519.81
|
| Rate for Payer: Humana Commercial |
$28,201.94
|
| Rate for Payer: Humana KY Medicaid |
$11,410.17
|
| Rate for Payer: Kentucky WC Medicaid |
$11,526.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,206.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,485.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,953.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,639.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,197.30
|
| Rate for Payer: Ohio Health Group HMO |
$24,884.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,635.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,313.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,285.41
|
| Rate for Payer: PHCS Commercial |
$31,851.60
|
| Rate for Payer: United Healthcare All Payer |
$29,197.30
|
|
|
STENT BIFUR 13.5CM 20M*12M
|
Facility
|
IP
|
$33,178.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,313.24 |
| Max. Negotiated Rate |
$31,851.60 |
| Rate for Payer: Aetna Commercial |
$25,547.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,879.42
|
| Rate for Payer: Cash Price |
$16,589.38
|
| Rate for Payer: Cigna Commercial |
$27,538.36
|
| Rate for Payer: First Health Commercial |
$31,519.81
|
| Rate for Payer: Humana Commercial |
$28,201.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,206.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,485.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,953.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,197.30
|
| Rate for Payer: Ohio Health Group HMO |
$24,884.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,635.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,313.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,285.41
|
| Rate for Payer: PHCS Commercial |
$31,851.60
|
| Rate for Payer: United Healthcare All Payer |
$29,197.30
|
|
|
STENT BIFUR 13.5CM 22M*13M
|
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 BIFUR 13.5CM 22M*13M
|
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 BIFUR 13.5CM 24M*14M
|
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 BIFUR 13.5CM 24M*14M
|
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 BIFUR 13.5CM 26M*15M
|
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 BIFUR 13.5CM 26M*15M
|
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 BIFUR 13.5CM 28M*16M
|
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 BIFUR 13.5CM 28M*16M
|
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 BIFUR 16.5CM 20M*12M
|
Facility
|
IP
|
$33,270.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.10 |
| Max. Negotiated Rate |
$31,939.20 |
| Rate for Payer: Aetna Commercial |
$25,617.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,950.60
|
| Rate for Payer: Cash Price |
$16,635.00
|
| Rate for Payer: Cigna Commercial |
$27,614.10
|
| Rate for Payer: First Health Commercial |
$31,606.50
|
| Rate for Payer: Humana Commercial |
$28,279.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,553.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,981.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,277.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,313.70
|
| Rate for Payer: PHCS Commercial |
$31,939.20
|
| Rate for Payer: United Healthcare All Payer |
$29,277.60
|
|
|
STENT BIFUR 16.5CM 20M*12M
|
Facility
|
OP
|
$33,270.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.10 |
| Max. Negotiated Rate |
$31,939.20 |
| Rate for Payer: Aetna Commercial |
$25,617.90
|
| Rate for Payer: Anthem Medicaid |
$11,441.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,950.60
|
| Rate for Payer: Cash Price |
$16,635.00
|
| Rate for Payer: Cigna Commercial |
$27,614.10
|
| Rate for Payer: First Health Commercial |
$31,606.50
|
| Rate for Payer: Humana Commercial |
$28,279.50
|
| Rate for Payer: Humana KY Medicaid |
$11,441.55
|
| Rate for Payer: Kentucky WC Medicaid |
$11,558.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,553.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,981.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,671.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,277.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,313.70
|
| Rate for Payer: PHCS Commercial |
$31,939.20
|
| Rate for Payer: United Healthcare All Payer |
$29,277.60
|
|
|
STENT BIFUR 16.5CM 22M*13M
|
Facility
|
OP
|
$33,270.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.10 |
| Max. Negotiated Rate |
$31,939.20 |
| Rate for Payer: Aetna Commercial |
$25,617.90
|
| Rate for Payer: Anthem Medicaid |
$11,441.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,950.60
|
| Rate for Payer: Cash Price |
$16,635.00
|
| Rate for Payer: Cigna Commercial |
$27,614.10
|
| Rate for Payer: First Health Commercial |
$31,606.50
|
| Rate for Payer: Humana Commercial |
$28,279.50
|
| Rate for Payer: Humana KY Medicaid |
$11,441.55
|
| Rate for Payer: Kentucky WC Medicaid |
$11,558.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,553.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,981.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,671.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,277.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,313.70
|
| Rate for Payer: PHCS Commercial |
$31,939.20
|
| Rate for Payer: United Healthcare All Payer |
$29,277.60
|
|
|
STENT BIFUR 16.5CM 22M*13M
|
Facility
|
IP
|
$33,270.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,325.10 |
| Max. Negotiated Rate |
$31,939.20 |
| Rate for Payer: Aetna Commercial |
$25,617.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,950.60
|
| Rate for Payer: Cash Price |
$16,635.00
|
| Rate for Payer: Cigna Commercial |
$27,614.10
|
| Rate for Payer: First Health Commercial |
$31,606.50
|
| Rate for Payer: Humana Commercial |
$28,279.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,553.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,981.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,277.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,313.70
|
| Rate for Payer: PHCS Commercial |
$31,939.20
|
| Rate for Payer: United Healthcare All Payer |
$29,277.60
|
|
