|
STENT EXPRESS LD 6MM*57MM
|
Facility
|
OP
|
$7,601.94
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.25 |
| Max. Negotiated Rate |
$7,297.86 |
| Rate for Payer: Aetna Commercial |
$5,853.49
|
| Rate for Payer: Anthem Medicaid |
$2,614.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,929.51
|
| Rate for Payer: Cash Price |
$3,800.97
|
| Rate for Payer: Cigna Commercial |
$6,309.61
|
| Rate for Payer: First Health Commercial |
$7,221.84
|
| Rate for Payer: Humana Commercial |
$6,461.65
|
| Rate for Payer: Humana KY Medicaid |
$2,614.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,640.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,233.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,610.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,280.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,666.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,689.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,701.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.60
|
| Rate for Payer: PHCS Commercial |
$7,297.86
|
| Rate for Payer: United Healthcare All Payer |
$6,689.71
|
|
|
STENT EXPRESS LD 7*17*135
|
Facility
|
OP
|
$6,959.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.74 |
| Max. Negotiated Rate |
$6,681.16 |
| Rate for Payer: Aetna Commercial |
$5,358.85
|
| Rate for Payer: Anthem Medicaid |
$2,393.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,428.44
|
| Rate for Payer: Cash Price |
$3,479.77
|
| Rate for Payer: Cigna Commercial |
$5,776.42
|
| Rate for Payer: First Health Commercial |
$6,611.56
|
| Rate for Payer: Humana Commercial |
$5,915.61
|
| Rate for Payer: Humana KY Medicaid |
$2,393.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,417.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,706.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,136.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,124.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,219.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.46
|
| Rate for Payer: PHCS Commercial |
$6,681.16
|
| Rate for Payer: United Healthcare All Payer |
$6,124.40
|
|
|
STENT EXPRESS LD 7*17*135
|
Facility
|
IP
|
$6,959.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.74 |
| Max. Negotiated Rate |
$6,681.16 |
| Rate for Payer: Aetna Commercial |
$5,358.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,428.44
|
| Rate for Payer: Cash Price |
$3,479.77
|
| Rate for Payer: Cigna Commercial |
$5,776.42
|
| Rate for Payer: First Health Commercial |
$6,611.56
|
| Rate for Payer: Humana Commercial |
$5,915.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,706.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,136.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,124.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,219.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.46
|
| Rate for Payer: PHCS Commercial |
$6,681.16
|
| Rate for Payer: United Healthcare All Payer |
$6,124.40
|
|
|
STENT EXPRESS LD 7MM*37MM
|
Facility
|
OP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem Medicaid |
$1,460.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Humana KY Medicaid |
$1,460.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
STENT EXPRESS LD 7MM*37MM
|
Facility
|
IP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
STENT EXPRESS LD 8MM*17MM
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
STENT EXPRESS LD 8MM*17MM
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
STENT EXPRESS LD 8MM*57MM*75
|
Facility
|
IP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
STENT EXPRESS LD 8MM*57MM*75
|
Facility
|
OP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem Medicaid |
$1,460.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Humana KY Medicaid |
$1,460.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
STENT EXPRESS LD 9MM*25MM*75
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
STENT EXPRESS LD 9MM*25MM*75
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
STENT G FLEX PIGTAIL 10F*5CM
|
Facility
|
OP
|
$1,731.50
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,333.26
|
| Rate for Payer: Anthem Medicaid |
$595.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.57
|
| Rate for Payer: Cash Price |
$865.75
|
| Rate for Payer: Cigna Commercial |
$1,437.14
|
| Rate for Payer: First Health Commercial |
$1,644.92
|
| Rate for Payer: Humana Commercial |
$1,471.78
|
| Rate for Payer: Humana KY Medicaid |
$595.46
|
| Rate for Payer: Kentucky WC Medicaid |
$601.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.76
|
| Rate for Payer: PHCS Commercial |
$1,662.24
|
| Rate for Payer: United Healthcare All Payer |
$1,523.72
|
|
|
STENT G FLEX PIGTAIL 10F*5CM
|
Facility
|
IP
|
$1,731.50
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,333.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.57
|
| Rate for Payer: Cash Price |
$865.75
|
| Rate for Payer: Cigna Commercial |
$1,437.14
|
| Rate for Payer: First Health Commercial |
$1,644.92
|
| Rate for Payer: Humana Commercial |
$1,471.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.76
|
| Rate for Payer: PHCS Commercial |
$1,662.24
|
| Rate for Payer: United Healthcare All Payer |
$1,523.72
|
|
|
STENT GFT AAA AORT EXT 3.75*20
|
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 GFT AAA AORT EXT 3.75*20
|
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 GFT AAA AORT EXT 3.75*26
|
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 GFT AAA AORT EXT 3.75*26
|
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 GFT AAA ILIAC EXT 5.5*12
|
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 GFT AAA ILIAC EXT 5.5*12
|
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 GFT AAA ILIAC EXT 5.5*13
|
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 GFT AAA ILIAC EXT 5.5*13
|
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 GFT AAA ILIAC EXT 5.5*14
|
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 GFT AAA ILIAC EXT 5.5*14
|
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 GFT AAA ILIAC EXT 5.5*15
|
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 GFT AAA ILIAC EXT 5.5*15
|
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
|
|
