|
STENT GRAFT AAA ILIAC 8.5*12
|
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 GRAFT AAA ILIAC 8.5*13
|
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 GRAFT AAA ILIAC 8.5*13
|
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 GRAFT AAA ILIAC 8.5*15
|
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 GRAFT AAA ILIAC 8.5*15
|
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 ILIAC FLR 16*20MM 11.5CM
|
Facility
|
OP
|
$13,976.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.91 |
| Max. Negotiated Rate |
$13,417.20 |
| Rate for Payer: Aetna Commercial |
$10,761.71
|
| Rate for Payer: Anthem Medicaid |
$4,806.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,901.48
|
| Rate for Payer: Cash Price |
$6,988.12
|
| Rate for Payer: Cigna Commercial |
$11,600.29
|
| Rate for Payer: First Health Commercial |
$13,277.44
|
| Rate for Payer: Humana Commercial |
$11,879.81
|
| Rate for Payer: Humana KY Medicaid |
$4,806.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,855.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,460.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,314.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,192.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,299.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,482.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,332.64
|
| Rate for Payer: PHCS Commercial |
$13,417.20
|
| Rate for Payer: United Healthcare All Payer |
$12,299.10
|
|
|
STENT ILIAC FLR 16*20MM 11.5CM
|
Facility
|
IP
|
$13,976.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.91 |
| Max. Negotiated Rate |
$13,417.20 |
| Rate for Payer: Aetna Commercial |
$10,761.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,901.48
|
| Rate for Payer: Cash Price |
$6,988.12
|
| Rate for Payer: Cigna Commercial |
$11,600.29
|
| Rate for Payer: First Health Commercial |
$13,277.44
|
| Rate for Payer: Humana Commercial |
$11,879.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,460.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,314.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,192.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,299.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,482.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,332.64
|
| Rate for Payer: PHCS Commercial |
$13,417.20
|
| Rate for Payer: United Healthcare All Payer |
$12,299.10
|
|
|
STENT ILIAC FLR 16*20MM 13.5CM
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
STENT ILIAC FLR 16*20MM 13.5CM
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
STENT ILIAC FLR 18*22MM 11.5CM
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
STENT ILIAC FLR 18*22MM 11.5CM
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
STENT ILIAC FLR 18*22MM 13.5CM
|
Facility
|
IP
|
$17,340.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.20 |
| Max. Negotiated Rate |
$16,646.40 |
| Rate for Payer: Aetna Commercial |
$13,351.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,525.20
|
| Rate for Payer: Cash Price |
$8,670.00
|
| Rate for Payer: Cigna Commercial |
$14,392.20
|
| Rate for Payer: First Health Commercial |
$16,473.00
|
| Rate for Payer: Humana Commercial |
$14,739.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,218.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,796.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,202.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,259.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,254.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,375.40
|
| Rate for Payer: PHCS Commercial |
$16,646.40
|
| Rate for Payer: United Healthcare All Payer |
$15,259.20
|
|
|
STENT ILIAC FLR 18*22MM 13.5CM
|
Facility
|
OP
|
$17,340.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.20 |
| Max. Negotiated Rate |
$16,646.40 |
| Rate for Payer: Aetna Commercial |
$13,351.80
|
| Rate for Payer: Anthem Medicaid |
$5,963.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,525.20
|
| Rate for Payer: Cash Price |
$8,670.00
|
| Rate for Payer: Cigna Commercial |
$14,392.20
|
| Rate for Payer: First Health Commercial |
$16,473.00
|
| Rate for Payer: Humana Commercial |
$14,739.00
|
| Rate for Payer: Humana KY Medicaid |
$5,963.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,023.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,218.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,796.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,202.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,082.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,259.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,254.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,375.40
|
| Rate for Payer: PHCS Commercial |
$16,646.40
|
| Rate for Payer: United Healthcare All Payer |
$15,259.20
|
|
|
STENT ILIAC FLR 18*24MM 11.5CM
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
STENT ILIAC FLR 18*24MM 11.5CM
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
STENT ILIAC FLR 18*24MM 13.5CM
|
Facility
|
IP
|
$17,340.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.20 |
| Max. Negotiated Rate |
$16,646.40 |
| Rate for Payer: Aetna Commercial |
$13,351.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,525.20
|
| Rate for Payer: Cash Price |
$8,670.00
|
| Rate for Payer: Cigna Commercial |
$14,392.20
|
| Rate for Payer: First Health Commercial |
$16,473.00
|
| Rate for Payer: Humana Commercial |
$14,739.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,218.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,796.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,202.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,259.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,254.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,375.40
|
| Rate for Payer: PHCS Commercial |
$16,646.40
|
| Rate for Payer: United Healthcare All Payer |
$15,259.20
|
|
|
STENT ILIAC FLR 18*24MM 13.5CM
|
Facility
|
OP
|
$17,340.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.20 |
| Max. Negotiated Rate |
$16,646.40 |
| Rate for Payer: Aetna Commercial |
$13,351.80
|
| Rate for Payer: Anthem Medicaid |
$5,963.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,525.20
|
| Rate for Payer: Cash Price |
$8,670.00
|
| Rate for Payer: Cigna Commercial |
$14,392.20
|
| Rate for Payer: First Health Commercial |
$16,473.00
|
| Rate for Payer: Humana Commercial |
$14,739.00
|
| Rate for Payer: Humana KY Medicaid |
$5,963.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6,023.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,218.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,796.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,202.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,082.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,259.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,254.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,375.40
|
| Rate for Payer: PHCS Commercial |
$16,646.40
|
| Rate for Payer: United Healthcare All Payer |
$15,259.20
|
|
|
STENT ILIAC STR 12*12MM 11.5CM
|
Facility
|
OP
|
$15,180.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.40 |
| Max. Negotiated Rate |
$14,572.80 |
| Rate for Payer: Aetna Commercial |
$11,688.60
|
| Rate for Payer: Anthem Medicaid |
$5,220.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,840.40
|
| Rate for Payer: Cash Price |
$7,590.00
|
| Rate for Payer: Cigna Commercial |
$12,599.40
|
| Rate for Payer: First Health Commercial |
$14,421.00
|
| Rate for Payer: Humana Commercial |
$12,903.00
|
| Rate for Payer: Humana KY Medicaid |
$5,220.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,273.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,447.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,202.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,358.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,705.80
|
| Rate for Payer: PHCS Commercial |
$14,572.80
|
| Rate for Payer: United Healthcare All Payer |
$13,358.40
|
|
|
STENT ILIAC STR 12*12MM 11.5CM
|
Facility
|
IP
|
$15,180.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.40 |
| Max. Negotiated Rate |
$14,572.80 |
| Rate for Payer: Aetna Commercial |
$11,688.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,840.40
|
| Rate for Payer: Cash Price |
$7,590.00
|
| Rate for Payer: Cigna Commercial |
$12,599.40
|
| Rate for Payer: First Health Commercial |
$14,421.00
|
| Rate for Payer: Humana Commercial |
$12,903.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,447.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,202.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,358.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,705.80
|
| Rate for Payer: PHCS Commercial |
$14,572.80
|
| Rate for Payer: United Healthcare All Payer |
$13,358.40
|
|
|
STENT ILIAC STR 12*12MM 13.5CM
|
Facility
|
IP
|
$15,360.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$14,745.60 |
| Rate for Payer: Aetna Commercial |
$11,827.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,980.80
|
| Rate for Payer: Cash Price |
$7,680.00
|
| Rate for Payer: Cigna Commercial |
$12,748.80
|
| Rate for Payer: First Health Commercial |
$14,592.00
|
| Rate for Payer: Humana Commercial |
$13,056.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,595.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,335.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,516.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,520.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,761.60
|
| Rate for Payer: PHCS Commercial |
$14,745.60
|
| Rate for Payer: United Healthcare All Payer |
$13,516.80
|
|
|
STENT ILIAC STR 12*12MM 13.5CM
|
Facility
|
OP
|
$15,360.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.80 |
| Max. Negotiated Rate |
$14,745.60 |
| Rate for Payer: Aetna Commercial |
$11,827.20
|
| Rate for Payer: Anthem Medicaid |
$5,282.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,980.80
|
| Rate for Payer: Cash Price |
$7,680.00
|
| Rate for Payer: Cigna Commercial |
$12,748.80
|
| Rate for Payer: First Health Commercial |
$14,592.00
|
| Rate for Payer: Humana Commercial |
$13,056.00
|
| Rate for Payer: Humana KY Medicaid |
$5,282.30
|
| Rate for Payer: Kentucky WC Medicaid |
$5,336.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,595.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,335.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,388.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,516.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,520.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,761.60
|
| Rate for Payer: PHCS Commercial |
$14,745.60
|
| Rate for Payer: United Healthcare All Payer |
$13,516.80
|
|
|
STENT ILIAC STR 12*12MM 8.5CM
|
Facility
|
IP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
STENT ILIAC STR 12*12MM 8.5CM
|
Facility
|
OP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem Medicaid |
$5,406.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Humana KY Medicaid |
$5,406.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,461.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
STENT ILIAC STR 13*13MM 11.5CM
|
Facility
|
IP
|
$13,428.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,745.74 |
| Max. Negotiated Rate |
$12,891.60 |
| Rate for Payer: Aetna Commercial |
$10,340.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,474.42
|
| Rate for Payer: Cash Price |
$6,714.38
|
| Rate for Payer: Cigna Commercial |
$11,145.86
|
| Rate for Payer: First Health Commercial |
$12,757.31
|
| Rate for Payer: Humana Commercial |
$11,414.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,011.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,910.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,028.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,817.30
|
| Rate for Payer: Ohio Health Group HMO |
$10,071.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,685.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,745.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,162.91
|
| Rate for Payer: PHCS Commercial |
$12,891.60
|
| Rate for Payer: United Healthcare All Payer |
$11,817.30
|
|
|
STENT ILIAC STR 13*13MM 11.5CM
|
Facility
|
OP
|
$13,428.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,745.74 |
| Max. Negotiated Rate |
$12,891.60 |
| Rate for Payer: Aetna Commercial |
$10,340.14
|
| Rate for Payer: Anthem Medicaid |
$4,618.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,474.42
|
| Rate for Payer: Cash Price |
$6,714.38
|
| Rate for Payer: Cigna Commercial |
$11,145.86
|
| Rate for Payer: First Health Commercial |
$12,757.31
|
| Rate for Payer: Humana Commercial |
$11,414.44
|
| Rate for Payer: Humana KY Medicaid |
$4,618.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,665.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,011.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,910.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,028.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,710.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,817.30
|
| Rate for Payer: Ohio Health Group HMO |
$10,071.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,685.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,745.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,162.91
|
| Rate for Payer: PHCS Commercial |
$12,891.60
|
| Rate for Payer: United Healthcare All Payer |
$11,817.30
|
|
