|
STENT PLACEMT ANTE CAROTID
|
Facility
|
IP
|
$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 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: 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: 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(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
761P1543
|
|
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
|
|
|
STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
76101542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.60
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
STENT PLACEMT RETRO CAROTID
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
76101542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$2,054.10 |
| Rate for Payer: Anthem Medicaid |
$906.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$2,054.10
|
| Rate for Payer: Healthspan PPO |
$1,484.35
|
| Rate for Payer: Humana Medicaid |
$906.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$924.30
|
| Rate for Payer: Molina Healthcare Passport |
$906.18
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$915.24
|
|
|
STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
76101542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
STENT PLACEMT RETRO CAROTID(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
761P1542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$2,054.10 |
| Rate for Payer: Anthem Medicaid |
$906.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$2,054.10
|
| Rate for Payer: Healthspan PPO |
$1,484.35
|
| Rate for Payer: Humana Medicaid |
$906.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$924.30
|
| Rate for Payer: Molina Healthcare Passport |
$906.18
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$915.24
|
|
|
STENT PLMT CTR DIALYSIS SEG
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
76101521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
STENT PLMT CTR DIALYSIS SEG
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
76101521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
STENT PLMT CTR DIALYSIS SEG
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
76101521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.06 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.45
|
| Rate for Payer: Anthem Medicaid |
$153.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$312.96
|
| Rate for Payer: Humana Medicaid |
$153.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$156.12
|
| Rate for Payer: Molina Healthcare Passport |
$153.06
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$168.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.59
|
|
|
STENT PLMT CTR DIALYSIS SEG(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
761P1521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.06 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.45
|
| Rate for Payer: Anthem Medicaid |
$153.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$312.96
|
| Rate for Payer: Humana Medicaid |
$153.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$156.12
|
| Rate for Payer: Molina Healthcare Passport |
$153.06
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$168.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.59
|
|
|
STENT PLYFLX ESOPH 23/18M*120M
|
Facility
|
OP
|
$11,194.95
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.34 |
| Max. Negotiated Rate |
$10,747.15 |
| Rate for Payer: Aetna Commercial |
$8,620.11
|
| Rate for Payer: Anthem Medicaid |
$3,849.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.06
|
| Rate for Payer: Cash Price |
$5,597.48
|
| Rate for Payer: Cigna Commercial |
$9,291.81
|
| Rate for Payer: First Health Commercial |
$10,635.20
|
| Rate for Payer: Humana Commercial |
$9,515.71
|
| Rate for Payer: Humana KY Medicaid |
$3,849.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,889.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,179.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,261.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,927.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,851.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,238.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,455.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,470.43
|
| Rate for Payer: PHCS Commercial |
$10,747.15
|
| Rate for Payer: United Healthcare All Payer |
$9,851.56
|
|
|
STENT PLYFLX ESOPH 23/18M*120M
|
Facility
|
IP
|
$11,194.95
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.34 |
| Max. Negotiated Rate |
$10,747.15 |
| Rate for Payer: Aetna Commercial |
$8,620.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.06
|
| Rate for Payer: Cash Price |
$5,597.48
|
| Rate for Payer: Cigna Commercial |
$9,291.81
|
| Rate for Payer: First Health Commercial |
$10,635.20
|
| Rate for Payer: Humana Commercial |
$9,515.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,179.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,261.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,851.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,238.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,455.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,470.43
|
| Rate for Payer: PHCS Commercial |
$10,747.15
|
| Rate for Payer: United Healthcare All Payer |
$9,851.56
|
|
|
STENT PLYFLX ESOPH 23/18MM*90M
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT PLYFLX ESOPH 23/18MM*90M
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT PLYFLX SELF EXP 16*70*10
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
STENT PLYFLX SELF EXP 16*70*10
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
STENT POLARIS LOOP URETERAL 6*
|
Facility
|
IP
|
$1,901.32
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.17 |
| Max. Negotiated Rate |
$1,825.27 |
| Rate for Payer: Aetna Commercial |
$1,464.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.03
|
| Rate for Payer: Cash Price |
$950.66
|
| Rate for Payer: Cigna Commercial |
$1,578.10
|
| Rate for Payer: First Health Commercial |
$1,806.25
|
| Rate for Payer: Humana Commercial |
$1,616.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,673.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.41
|
| Rate for Payer: PHCS Commercial |
$1,825.27
|
| Rate for Payer: United Healthcare All Payer |
$1,673.16
|
|
|
STENT POLARIS LOOP URETERAL 6*
|
Facility
|
OP
|
$1,901.32
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.17 |
| Max. Negotiated Rate |
$1,825.27 |
| Rate for Payer: Aetna Commercial |
$1,464.02
|
| Rate for Payer: Anthem Medicaid |
$653.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.03
|
| Rate for Payer: Cash Price |
$950.66
|
| Rate for Payer: Cigna Commercial |
$1,578.10
|
| Rate for Payer: First Health Commercial |
$1,806.25
|
| Rate for Payer: Humana Commercial |
$1,616.12
|
| Rate for Payer: Humana KY Medicaid |
$653.86
|
| Rate for Payer: Kentucky WC Medicaid |
$660.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,673.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.41
|
| Rate for Payer: PHCS Commercial |
$1,825.27
|
| Rate for Payer: United Healthcare All Payer |
$1,673.16
|
|
|
STENT POLARIS URETERAL 5.0*26
|
Facility
|
OP
|
$1,827.43
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$1,754.33 |
| Rate for Payer: Aetna Commercial |
$1,407.12
|
| Rate for Payer: Anthem Medicaid |
$628.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.40
|
| Rate for Payer: Cash Price |
$913.72
|
| Rate for Payer: Cigna Commercial |
$1,516.77
|
| Rate for Payer: First Health Commercial |
$1,736.06
|
| Rate for Payer: Humana Commercial |
$1,553.32
|
| Rate for Payer: Humana KY Medicaid |
$628.45
|
| Rate for Payer: Kentucky WC Medicaid |
$634.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.50
|
| Rate for Payer: PHCS Commercial |
$1,754.33
|
| Rate for Payer: United Healthcare All Payer |
$1,608.14
|
|
|
STENT POLARIS URETERAL 5.0*26
|
Facility
|
IP
|
$1,827.43
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$1,754.33 |
| Rate for Payer: Aetna Commercial |
$1,407.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.40
|
| Rate for Payer: Cash Price |
$913.72
|
| Rate for Payer: Cigna Commercial |
$1,516.77
|
| Rate for Payer: First Health Commercial |
$1,736.06
|
| Rate for Payer: Humana Commercial |
$1,553.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.50
|
| Rate for Payer: PHCS Commercial |
$1,754.33
|
| Rate for Payer: United Healthcare All Payer |
$1,608.14
|
|
|
STENT POLARIS URETERAL 5*22
|
Facility
|
IP
|
$1,827.43
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$1,754.33 |
| Rate for Payer: Aetna Commercial |
$1,407.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.40
|
| Rate for Payer: Cash Price |
$913.72
|
| Rate for Payer: Cigna Commercial |
$1,516.77
|
| Rate for Payer: First Health Commercial |
$1,736.06
|
| Rate for Payer: Humana Commercial |
$1,553.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.50
|
| Rate for Payer: PHCS Commercial |
$1,754.33
|
| Rate for Payer: United Healthcare All Payer |
$1,608.14
|
|
|
STENT POLARIS URETERAL 5*22
|
Facility
|
OP
|
$1,827.43
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$1,754.33 |
| Rate for Payer: Aetna Commercial |
$1,407.12
|
| Rate for Payer: Anthem Medicaid |
$628.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.40
|
| Rate for Payer: Cash Price |
$913.72
|
| Rate for Payer: Cigna Commercial |
$1,516.77
|
| Rate for Payer: First Health Commercial |
$1,736.06
|
| Rate for Payer: Humana Commercial |
$1,553.32
|
| Rate for Payer: Humana KY Medicaid |
$628.45
|
| Rate for Payer: Kentucky WC Medicaid |
$634.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.50
|
| Rate for Payer: PHCS Commercial |
$1,754.33
|
| Rate for Payer: United Healthcare All Payer |
$1,608.14
|
|
|
STENT POLARIS URETERAL 5*24
|
Facility
|
IP
|
$1,827.43
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$1,754.33 |
| Rate for Payer: Aetna Commercial |
$1,407.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.40
|
| Rate for Payer: Cash Price |
$913.72
|
| Rate for Payer: Cigna Commercial |
$1,516.77
|
| Rate for Payer: First Health Commercial |
$1,736.06
|
| Rate for Payer: Humana Commercial |
$1,553.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.50
|
| Rate for Payer: PHCS Commercial |
$1,754.33
|
| Rate for Payer: United Healthcare All Payer |
$1,608.14
|
|
|
STENT POLARIS URETERAL 5*24
|
Facility
|
OP
|
$1,827.43
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.57 |
| Max. Negotiated Rate |
$1,754.33 |
| Rate for Payer: Aetna Commercial |
$1,407.12
|
| Rate for Payer: Anthem Medicaid |
$628.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.40
|
| Rate for Payer: Cash Price |
$913.72
|
| Rate for Payer: Cigna Commercial |
$1,516.77
|
| Rate for Payer: First Health Commercial |
$1,736.06
|
| Rate for Payer: Humana Commercial |
$1,553.32
|
| Rate for Payer: Humana KY Medicaid |
$628.45
|
| Rate for Payer: Kentucky WC Medicaid |
$634.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.50
|
| Rate for Payer: PHCS Commercial |
$1,754.33
|
| Rate for Payer: United Healthcare All Payer |
$1,608.14
|
|
|
STENT POLARIS URETERAL 5*28
|
Facility
|
OP
|
$1,842.20
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.49 |
| Max. Negotiated Rate |
$1,768.51 |
| Rate for Payer: Aetna Commercial |
$1,418.49
|
| Rate for Payer: Anthem Medicaid |
$633.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,436.92
|
| Rate for Payer: Cash Price |
$921.10
|
| Rate for Payer: Cigna Commercial |
$1,529.03
|
| Rate for Payer: First Health Commercial |
$1,750.09
|
| Rate for Payer: Humana Commercial |
$1,565.87
|
| Rate for Payer: Humana KY Medicaid |
$633.53
|
| Rate for Payer: Kentucky WC Medicaid |
$639.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,510.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,359.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,621.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,381.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.08
|
| Rate for Payer: PHCS Commercial |
$1,768.51
|
| Rate for Payer: United Healthcare All Payer |
$1,621.14
|
|
