|
STENT ILIAC STR 13*13MM 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 13*13MM 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 13*13MM 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 13*13MM 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 14*14MM 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
|
|
|
STENT ILIAC STR 14*14MM 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 14*14MM 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 14*14MM 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 14*14MM 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 14*14MM 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 15*15MM 11.5CM
|
Facility
|
OP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem Medicaid |
$5,529.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Humana KY Medicaid |
$5,529.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,586.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,640.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STENT ILIAC STR 15*15MM 11.5CM
|
Facility
|
IP
|
$16,080.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.40 |
| Max. Negotiated Rate |
$15,436.80 |
| Rate for Payer: Aetna Commercial |
$12,381.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,542.40
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cigna Commercial |
$13,346.40
|
| Rate for Payer: First Health Commercial |
$15,276.00
|
| Rate for Payer: Humana Commercial |
$13,668.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,185.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,867.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,150.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,060.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,090.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,984.80
|
| Rate for Payer: PHCS Commercial |
$15,436.80
|
| Rate for Payer: United Healthcare All Payer |
$14,150.40
|
|
|
STENT ILIAC STR 15*15MM 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 15*15MM 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 15*15MM 8.5CM
|
Facility
|
IP
|
$13,063.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.29 |
| Max. Negotiated Rate |
$12,541.20 |
| Rate for Payer: Aetna Commercial |
$10,059.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,189.72
|
| Rate for Payer: Cash Price |
$6,531.88
|
| Rate for Payer: Cigna Commercial |
$10,842.91
|
| Rate for Payer: First Health Commercial |
$12,410.56
|
| Rate for Payer: Humana Commercial |
$11,104.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,712.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,641.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,496.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,797.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,612.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,698.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,049.76
|
| Rate for Payer: PHCS Commercial |
$12,541.20
|
| Rate for Payer: United Healthcare All Payer |
$11,496.10
|
|
|
STENT ILIAC STR 15*15MM 8.5CM
|
Facility
|
OP
|
$13,063.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.29 |
| Max. Negotiated Rate |
$12,541.20 |
| Rate for Payer: Aetna Commercial |
$10,059.09
|
| Rate for Payer: Anthem Medicaid |
$4,492.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,189.72
|
| Rate for Payer: Cash Price |
$6,531.88
|
| Rate for Payer: Cigna Commercial |
$10,842.91
|
| Rate for Payer: First Health Commercial |
$12,410.56
|
| Rate for Payer: Humana Commercial |
$11,104.19
|
| Rate for Payer: Humana KY Medicaid |
$4,492.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,538.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,712.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,641.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,496.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,797.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,612.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,698.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,049.76
|
| Rate for Payer: PHCS Commercial |
$12,541.20
|
| Rate for Payer: United Healthcare All Payer |
$11,496.10
|
|
|
STENT ILIAC STR 16*16MM 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 16*16MM 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 16*16MM 13.5CM
|
Facility
|
OP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem Medicaid |
$5,901.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Humana KY Medicaid |
$5,901.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
STENT ILIAC STR 16*16MM 13.5CM
|
Facility
|
IP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
STENT ILIAC STR 16*16MM 8.5CM
|
Facility
|
IP
|
$13,063.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.29 |
| Max. Negotiated Rate |
$12,541.20 |
| Rate for Payer: Aetna Commercial |
$10,059.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,189.72
|
| Rate for Payer: Cash Price |
$6,531.88
|
| Rate for Payer: Cigna Commercial |
$10,842.91
|
| Rate for Payer: First Health Commercial |
$12,410.56
|
| Rate for Payer: Humana Commercial |
$11,104.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,712.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,641.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,496.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,797.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,612.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,698.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,049.76
|
| Rate for Payer: PHCS Commercial |
$12,541.20
|
| Rate for Payer: United Healthcare All Payer |
$11,496.10
|
|
|
STENT ILIAC STR 16*16MM 8.5CM
|
Facility
|
OP
|
$13,063.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.29 |
| Max. Negotiated Rate |
$12,541.20 |
| Rate for Payer: Aetna Commercial |
$10,059.09
|
| Rate for Payer: Anthem Medicaid |
$4,492.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,189.72
|
| Rate for Payer: Cash Price |
$6,531.88
|
| Rate for Payer: Cigna Commercial |
$10,842.91
|
| Rate for Payer: First Health Commercial |
$12,410.56
|
| Rate for Payer: Humana Commercial |
$11,104.19
|
| Rate for Payer: Humana KY Medicaid |
$4,492.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,538.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,712.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,641.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,496.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,797.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,612.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,698.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,049.76
|
| Rate for Payer: PHCS Commercial |
$12,541.20
|
| Rate for Payer: United Healthcare All Payer |
$11,496.10
|
|
|
STENT ILIAC STR 18*18MM 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 STR 18*18MM 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 STR 18*18MM 13.5CM
|
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
|
|
