|
STENT ILIAC STR 18*18MM 13.5CM
|
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 18*18MM 8.5CM
|
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 18*18MM 8.5CM
|
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 20*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 STR 20*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 STR 20*20MM 13.5CM
|
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 20*20MM 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
|
|
|
STENT ILIAC STR 20*20MM 8.5CM
|
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 20*20MM 8.5CM
|
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 LITHOSTENT 7*26
|
Facility
|
IP
|
$2,081.50
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,998.24 |
| Rate for Payer: Aetna Commercial |
$1,602.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.57
|
| Rate for Payer: Cash Price |
$1,040.75
|
| Rate for Payer: Cigna Commercial |
$1,727.64
|
| Rate for Payer: First Health Commercial |
$1,977.42
|
| Rate for Payer: Humana Commercial |
$1,769.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,536.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,561.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.26
|
| Rate for Payer: PHCS Commercial |
$1,998.24
|
| Rate for Payer: United Healthcare All Payer |
$1,831.72
|
|
|
STENT LITHOSTENT 7*26
|
Facility
|
OP
|
$2,081.50
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,998.24 |
| Rate for Payer: Aetna Commercial |
$1,602.76
|
| Rate for Payer: Anthem Medicaid |
$715.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.57
|
| Rate for Payer: Cash Price |
$1,040.75
|
| Rate for Payer: Cigna Commercial |
$1,727.64
|
| Rate for Payer: First Health Commercial |
$1,977.42
|
| Rate for Payer: Humana Commercial |
$1,769.28
|
| Rate for Payer: Humana KY Medicaid |
$715.83
|
| Rate for Payer: Kentucky WC Medicaid |
$723.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,536.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,561.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.26
|
| Rate for Payer: PHCS Commercial |
$1,998.24
|
| Rate for Payer: United Healthcare All Payer |
$1,831.72
|
|
|
STENT LITHOSTENT 7*28
|
Facility
|
OP
|
$2,081.50
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,998.24 |
| Rate for Payer: Aetna Commercial |
$1,602.76
|
| Rate for Payer: Anthem Medicaid |
$715.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.57
|
| Rate for Payer: Cash Price |
$1,040.75
|
| Rate for Payer: Cigna Commercial |
$1,727.64
|
| Rate for Payer: First Health Commercial |
$1,977.42
|
| Rate for Payer: Humana Commercial |
$1,769.28
|
| Rate for Payer: Humana KY Medicaid |
$715.83
|
| Rate for Payer: Kentucky WC Medicaid |
$723.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,536.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,561.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.26
|
| Rate for Payer: PHCS Commercial |
$1,998.24
|
| Rate for Payer: United Healthcare All Payer |
$1,831.72
|
|
|
STENT LITHOSTENT 7*28
|
Facility
|
IP
|
$2,081.50
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,998.24 |
| Rate for Payer: Aetna Commercial |
$1,602.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.57
|
| Rate for Payer: Cash Price |
$1,040.75
|
| Rate for Payer: Cigna Commercial |
$1,727.64
|
| Rate for Payer: First Health Commercial |
$1,977.42
|
| Rate for Payer: Humana Commercial |
$1,769.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,536.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,561.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.26
|
| Rate for Payer: PHCS Commercial |
$1,998.24
|
| Rate for Payer: United Healthcare All Payer |
$1,831.72
|
|
|
STENT NIR ROYAL 5.0MM*14MM
|
Facility
|
OP
|
$7,243.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.61 |
| Max. Negotiated Rate |
$6,953.42 |
| Rate for Payer: Aetna Commercial |
$5,577.23
|
| Rate for Payer: Anthem Medicaid |
$2,490.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.66
|
| Rate for Payer: Cash Price |
$3,621.57
|
| Rate for Payer: Cigna Commercial |
$6,011.81
|
| Rate for Payer: First Health Commercial |
$6,880.99
|
| Rate for Payer: Humana Commercial |
$6,156.68
|
| Rate for Payer: Humana KY Medicaid |
$2,490.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,245.38
|
| Rate for Payer: PHCS Commercial |
$6,953.42
|
| Rate for Payer: United Healthcare All Payer |
$6,373.97
|
|
|
STENT NIR ROYAL 5.0MM*14MM
|
Facility
|
IP
|
$7,243.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.61 |
| Max. Negotiated Rate |
$6,953.42 |
| Rate for Payer: Aetna Commercial |
$5,577.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.66
|
| Rate for Payer: Cash Price |
$3,621.57
|
| Rate for Payer: Cigna Commercial |
$6,011.81
|
| Rate for Payer: First Health Commercial |
$6,880.99
|
| Rate for Payer: Humana Commercial |
$6,156.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,245.38
|
| Rate for Payer: PHCS Commercial |
$6,953.42
|
| Rate for Payer: United Healthcare All Payer |
$6,373.97
|
|
|
STENT NIR ROYAL 5.0MM*19MM
|
Facility
|
IP
|
$7,243.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.61 |
| Max. Negotiated Rate |
$6,953.42 |
| Rate for Payer: Aetna Commercial |
$5,577.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.66
|
| Rate for Payer: Cash Price |
$3,621.57
|
| Rate for Payer: Cigna Commercial |
$6,011.81
|
| Rate for Payer: First Health Commercial |
$6,880.99
|
| Rate for Payer: Humana Commercial |
$6,156.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,245.38
|
| Rate for Payer: PHCS Commercial |
$6,953.42
|
| Rate for Payer: United Healthcare All Payer |
$6,373.97
|
|
|
STENT NIR ROYAL 5.0MM*19MM
|
Facility
|
OP
|
$7,243.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.61 |
| Max. Negotiated Rate |
$6,953.42 |
| Rate for Payer: Aetna Commercial |
$5,577.23
|
| Rate for Payer: Anthem Medicaid |
$2,490.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.66
|
| Rate for Payer: Cash Price |
$3,621.57
|
| Rate for Payer: Cigna Commercial |
$6,011.81
|
| Rate for Payer: First Health Commercial |
$6,880.99
|
| Rate for Payer: Humana Commercial |
$6,156.68
|
| Rate for Payer: Humana KY Medicaid |
$2,490.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,448.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,245.38
|
| Rate for Payer: PHCS Commercial |
$6,953.42
|
| Rate for Payer: United Healthcare All Payer |
$6,373.97
|
|
|
STENT PALMAZ GENESIS 29
|
Facility
|
OP
|
$6,577.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.11 |
| Max. Negotiated Rate |
$6,314.64 |
| Rate for Payer: Aetna Commercial |
$5,064.87
|
| Rate for Payer: Anthem Medicaid |
$2,262.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,130.64
|
| Rate for Payer: Cash Price |
$3,288.88
|
| Rate for Payer: Cigna Commercial |
$5,459.53
|
| Rate for Payer: First Health Commercial |
$6,248.86
|
| Rate for Payer: Humana Commercial |
$5,591.09
|
| Rate for Payer: Humana KY Medicaid |
$2,262.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,285.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,393.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,307.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,788.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,315.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.10
|
| Rate for Payer: PHCS Commercial |
$6,314.64
|
| Rate for Payer: United Healthcare All Payer |
$5,788.42
|
|
|
STENT PALMAZ GENESIS 29
|
Facility
|
IP
|
$6,577.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$855.11 |
| Max. Negotiated Rate |
$6,314.64 |
| Rate for Payer: Aetna Commercial |
$5,064.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,130.64
|
| Rate for Payer: Cash Price |
$3,288.88
|
| Rate for Payer: Cigna Commercial |
$5,459.53
|
| Rate for Payer: First Health Commercial |
$6,248.86
|
| Rate for Payer: Humana Commercial |
$5,591.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,393.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,854.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,973.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,788.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,315.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$855.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.10
|
| Rate for Payer: PHCS Commercial |
$6,314.64
|
| Rate for Payer: United Healthcare All Payer |
$5,788.42
|
|
|
STENT PALMAZ GENSIS 9*35 SNGLE
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
STENT PALMAZ GENSIS 9*35 SNGLE
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
STENT PERCUFLEX NEPHROURETERAL
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
STENT PERCUFLEX NEPHROURETERAL
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
STENT PLACEMT ANTE CAROTID
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
76101543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
STENT PLACEMT ANTE CAROTID
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
76101543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$1,520.38 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$657.38
|
| Rate for Payer: Anthem Medicaid |
$672.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,520.38
|
| Rate for Payer: Humana Medicaid |
$672.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$685.77
|
| Rate for Payer: Molina Healthcare Passport |
$672.32
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$690.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$679.04
|
|
