|
STENT POLARIS URETERAL 5*28
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
STENT POLARIS URETERAL 6.0*22
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
STENT POLARIS URETERAL 6.0*22
|
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
|
|
|
STENT POLARIS URETERAL 6.0*24
|
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
|
|
|
STENT POLARIS URETERAL 6.0*24
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
STENT POLARIS URETERAL 6.0*26
|
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
|
|
|
STENT POLARIS URETERAL 6.0*26
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
STENT POLARIS URETERAL 6*28
|
Facility
|
IP
|
$1,852.25
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$1,778.16 |
| Rate for Payer: Aetna Commercial |
$1,426.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.76
|
| Rate for Payer: Cash Price |
$926.12
|
| Rate for Payer: Cigna Commercial |
$1,537.37
|
| Rate for Payer: First Health Commercial |
$1,759.64
|
| Rate for Payer: Humana Commercial |
$1,574.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.20
|
| Rate for Payer: PHCS Commercial |
$1,778.16
|
| Rate for Payer: United Healthcare All Payer |
$1,629.98
|
|
|
STENT POLARIS URETERAL 6*28
|
Facility
|
OP
|
$1,852.25
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$1,778.16 |
| Rate for Payer: Aetna Commercial |
$1,426.23
|
| Rate for Payer: Anthem Medicaid |
$636.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.76
|
| Rate for Payer: Cash Price |
$926.12
|
| Rate for Payer: Cigna Commercial |
$1,537.37
|
| Rate for Payer: First Health Commercial |
$1,759.64
|
| Rate for Payer: Humana Commercial |
$1,574.41
|
| Rate for Payer: Humana KY Medicaid |
$636.99
|
| Rate for Payer: Kentucky WC Medicaid |
$643.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.20
|
| Rate for Payer: PHCS Commercial |
$1,778.16
|
| Rate for Payer: United Healthcare All Payer |
$1,629.98
|
|
|
STENT POLARIS URETERAL 7*22
|
Facility
|
OP
|
$1,817.88
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,399.77
|
| Rate for Payer: Anthem Medicaid |
$625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.95
|
| Rate for Payer: Cash Price |
$908.94
|
| Rate for Payer: Cigna Commercial |
$1,508.84
|
| Rate for Payer: First Health Commercial |
$1,726.99
|
| Rate for Payer: Humana Commercial |
$1,545.20
|
| Rate for Payer: Humana KY Medicaid |
$625.17
|
| Rate for Payer: Kentucky WC Medicaid |
$631.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.54
|
| Rate for Payer: PHCS Commercial |
$1,745.16
|
| Rate for Payer: United Healthcare All Payer |
$1,599.73
|
|
|
STENT POLARIS URETERAL 7*22
|
Facility
|
IP
|
$1,817.88
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,399.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.95
|
| Rate for Payer: Cash Price |
$908.94
|
| Rate for Payer: Cigna Commercial |
$1,508.84
|
| Rate for Payer: First Health Commercial |
$1,726.99
|
| Rate for Payer: Humana Commercial |
$1,545.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.54
|
| Rate for Payer: PHCS Commercial |
$1,745.16
|
| Rate for Payer: United Healthcare All Payer |
$1,599.73
|
|
|
STENT POLARIS URETERAL 7*24
|
Facility
|
IP
|
$1,817.88
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,399.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.95
|
| Rate for Payer: Cash Price |
$908.94
|
| Rate for Payer: Cigna Commercial |
$1,508.84
|
| Rate for Payer: First Health Commercial |
$1,726.99
|
| Rate for Payer: Humana Commercial |
$1,545.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.54
|
| Rate for Payer: PHCS Commercial |
$1,745.16
|
| Rate for Payer: United Healthcare All Payer |
$1,599.73
|
|
|
STENT POLARIS URETERAL 7*24
|
Facility
|
OP
|
$1,817.88
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,399.77
|
| Rate for Payer: Anthem Medicaid |
$625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.95
|
| Rate for Payer: Cash Price |
$908.94
|
| Rate for Payer: Cigna Commercial |
$1,508.84
|
| Rate for Payer: First Health Commercial |
$1,726.99
|
| Rate for Payer: Humana Commercial |
$1,545.20
|
| Rate for Payer: Humana KY Medicaid |
$625.17
|
| Rate for Payer: Kentucky WC Medicaid |
$631.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.54
|
| Rate for Payer: PHCS Commercial |
$1,745.16
|
| Rate for Payer: United Healthcare All Payer |
$1,599.73
|
|
|
STENT POLARIS URETERAL 7*26
|
Facility
|
IP
|
$1,817.88
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,399.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.95
|
| Rate for Payer: Cash Price |
$908.94
|
| Rate for Payer: Cigna Commercial |
$1,508.84
|
| Rate for Payer: First Health Commercial |
$1,726.99
|
| Rate for Payer: Humana Commercial |
$1,545.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.54
|
| Rate for Payer: PHCS Commercial |
$1,745.16
|
| Rate for Payer: United Healthcare All Payer |
$1,599.73
|
|
|
STENT POLARIS URETERAL 7*26
|
Facility
|
OP
|
$1,817.88
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,399.77
|
| Rate for Payer: Anthem Medicaid |
$625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.95
|
| Rate for Payer: Cash Price |
$908.94
|
| Rate for Payer: Cigna Commercial |
$1,508.84
|
| Rate for Payer: First Health Commercial |
$1,726.99
|
| Rate for Payer: Humana Commercial |
$1,545.20
|
| Rate for Payer: Humana KY Medicaid |
$625.17
|
| Rate for Payer: Kentucky WC Medicaid |
$631.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.54
|
| Rate for Payer: PHCS Commercial |
$1,745.16
|
| Rate for Payer: United Healthcare All Payer |
$1,599.73
|
|
|
STENT POLARIS URETERAL 7*28
|
Facility
|
OP
|
$1,852.25
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$1,778.16 |
| Rate for Payer: Aetna Commercial |
$1,426.23
|
| Rate for Payer: Anthem Medicaid |
$636.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.76
|
| Rate for Payer: Cash Price |
$926.12
|
| Rate for Payer: Cigna Commercial |
$1,537.37
|
| Rate for Payer: First Health Commercial |
$1,759.64
|
| Rate for Payer: Humana Commercial |
$1,574.41
|
| Rate for Payer: Humana KY Medicaid |
$636.99
|
| Rate for Payer: Kentucky WC Medicaid |
$643.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.20
|
| Rate for Payer: PHCS Commercial |
$1,778.16
|
| Rate for Payer: United Healthcare All Payer |
$1,629.98
|
|
|
STENT POLARIS URETERAL 7*28
|
Facility
|
IP
|
$1,852.25
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$1,778.16 |
| Rate for Payer: Aetna Commercial |
$1,426.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.76
|
| Rate for Payer: Cash Price |
$926.12
|
| Rate for Payer: Cigna Commercial |
$1,537.37
|
| Rate for Payer: First Health Commercial |
$1,759.64
|
| Rate for Payer: Humana Commercial |
$1,574.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.20
|
| Rate for Payer: PHCS Commercial |
$1,778.16
|
| Rate for Payer: United Healthcare All Payer |
$1,629.98
|
|
|
STENT POLYFLEX 18*40 SELF EXP
|
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 POLYFLEX 18*40 SELF EXP
|
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 POLYFLEX 20*4 SELF EXP
|
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 POLYFLEX 20*4 SELF EXP
|
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 POLYFLEX 20*80 SELF EXP
|
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 POLYFLEX 20*80 SELF EXP
|
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 POLYFLEX 22*80 SELF EXP
|
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 POLYFLEX 22*80 SELF EXP
|
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
|
|
