|
STENT SENTINOLBIL 8*42*135
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
STENT SENTINOLBIL 8*81*135
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
STENT SENTINOLBIL 8*81*135
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
STENT SURGITEK DBL J 6FR*22CM
|
Facility
|
IP
|
$1,977.52
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.08 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Aetna Commercial |
$1,522.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.47
|
| Rate for Payer: Cash Price |
$988.76
|
| Rate for Payer: Cigna Commercial |
$1,641.34
|
| Rate for Payer: First Health Commercial |
$1,878.64
|
| Rate for Payer: Humana Commercial |
$1,680.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,740.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,483.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.03
|
| Rate for Payer: PHCS Commercial |
$1,898.42
|
| Rate for Payer: United Healthcare All Payer |
$1,740.22
|
|
|
STENT SURGITEK DBL J 6FR*22CM
|
Facility
|
OP
|
$1,977.52
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.08 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Aetna Commercial |
$1,522.69
|
| Rate for Payer: Anthem Medicaid |
$680.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.47
|
| Rate for Payer: Cash Price |
$988.76
|
| Rate for Payer: Cigna Commercial |
$1,641.34
|
| Rate for Payer: First Health Commercial |
$1,878.64
|
| Rate for Payer: Humana Commercial |
$1,680.89
|
| Rate for Payer: Humana KY Medicaid |
$680.07
|
| Rate for Payer: Kentucky WC Medicaid |
$686.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$693.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,740.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,483.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.03
|
| Rate for Payer: PHCS Commercial |
$1,898.42
|
| Rate for Payer: United Healthcare All Payer |
$1,740.22
|
|
|
STENT SURGITEK DBL J 6FR*24CM
|
Facility
|
OP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem Medicaid |
$686.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Humana KY Medicaid |
$686.53
|
| Rate for Payer: Kentucky WC Medicaid |
$693.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*24CM
|
Facility
|
IP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*26CM
|
Facility
|
IP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*26CM
|
Facility
|
OP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem Medicaid |
$686.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Humana KY Medicaid |
$686.53
|
| Rate for Payer: Kentucky WC Medicaid |
$693.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*28CM
|
Facility
|
OP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem Medicaid |
$686.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Humana KY Medicaid |
$686.53
|
| Rate for Payer: Kentucky WC Medicaid |
$693.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*28CM
|
Facility
|
IP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*30CM
|
Facility
|
IP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SURGITEK DBL J 6FR*30CM
|
Facility
|
OP
|
$1,996.31
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.52 |
| Max. Negotiated Rate |
$1,916.46 |
| Rate for Payer: Aetna Commercial |
$1,537.16
|
| Rate for Payer: Anthem Medicaid |
$686.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.12
|
| Rate for Payer: Cash Price |
$998.16
|
| Rate for Payer: Cigna Commercial |
$1,656.94
|
| Rate for Payer: First Health Commercial |
$1,896.49
|
| Rate for Payer: Humana Commercial |
$1,696.86
|
| Rate for Payer: Humana KY Medicaid |
$686.53
|
| Rate for Payer: Kentucky WC Medicaid |
$693.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.86
|
| Rate for Payer: PHCS Commercial |
$1,916.46
|
| Rate for Payer: United Healthcare All Payer |
$1,756.75
|
|
|
STENT SYMPHONY NITINOL 6*40
|
Facility
|
OP
|
$6,800.55
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.07 |
| Max. Negotiated Rate |
$6,528.53 |
| Rate for Payer: Aetna Commercial |
$5,236.42
|
| Rate for Payer: Anthem Medicaid |
$2,338.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.43
|
| Rate for Payer: Cash Price |
$3,400.27
|
| Rate for Payer: Cigna Commercial |
$5,644.46
|
| Rate for Payer: First Health Commercial |
$6,460.52
|
| Rate for Payer: Humana Commercial |
$5,780.47
|
| Rate for Payer: Humana KY Medicaid |
$2,338.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,018.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.17
|
| Rate for Payer: PHCS Commercial |
$6,528.53
|
| Rate for Payer: United Healthcare All Payer |
$5,984.48
|
|
|
STENT SYMPHONY NITINOL 6*40
|
Facility
|
IP
|
$6,800.55
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.07 |
| Max. Negotiated Rate |
$6,528.53 |
| Rate for Payer: Aetna Commercial |
$5,236.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.43
|
| Rate for Payer: Cash Price |
$3,400.27
|
| Rate for Payer: Cigna Commercial |
$5,644.46
|
| Rate for Payer: First Health Commercial |
$6,460.52
|
| Rate for Payer: Humana Commercial |
$5,780.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,018.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.17
|
| Rate for Payer: PHCS Commercial |
$6,528.53
|
| Rate for Payer: United Healthcare All Payer |
$5,984.48
|
|
|
STENT TALENT AAA BIF 24*14*140
|
Facility
|
IP
|
$35,551.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.66 |
| Max. Negotiated Rate |
$34,129.20 |
| Rate for Payer: Aetna Commercial |
$27,374.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.98
|
| Rate for Payer: Cash Price |
$17,775.62
|
| Rate for Payer: Cigna Commercial |
$29,507.54
|
| Rate for Payer: First Health Commercial |
$33,773.69
|
| Rate for Payer: Humana Commercial |
$30,218.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,152.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,285.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,663.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.89
|
| Rate for Payer: PHCS Commercial |
$34,129.20
|
| Rate for Payer: United Healthcare All Payer |
$31,285.10
|
|
|
STENT TALENT AAA BIF 24*14*140
|
Facility
|
OP
|
$35,551.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.66 |
| Max. Negotiated Rate |
$34,129.20 |
| Rate for Payer: Aetna Commercial |
$27,374.46
|
| Rate for Payer: Anthem Medicaid |
$12,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.98
|
| Rate for Payer: Cash Price |
$17,775.62
|
| Rate for Payer: Cigna Commercial |
$29,507.54
|
| Rate for Payer: First Health Commercial |
$33,773.69
|
| Rate for Payer: Humana Commercial |
$30,218.56
|
| Rate for Payer: Humana KY Medicaid |
$12,226.07
|
| Rate for Payer: Kentucky WC Medicaid |
$12,350.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,152.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,285.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,663.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.89
|
| Rate for Payer: PHCS Commercial |
$34,129.20
|
| Rate for Payer: United Healthcare All Payer |
$31,285.10
|
|
|
STENT TALENT AAA BIF 26*14*140
|
Facility
|
OP
|
$35,551.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.66 |
| Max. Negotiated Rate |
$34,129.20 |
| Rate for Payer: Aetna Commercial |
$27,374.46
|
| Rate for Payer: Anthem Medicaid |
$12,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.98
|
| Rate for Payer: Cash Price |
$17,775.62
|
| Rate for Payer: Cigna Commercial |
$29,507.54
|
| Rate for Payer: First Health Commercial |
$33,773.69
|
| Rate for Payer: Humana Commercial |
$30,218.56
|
| Rate for Payer: Humana KY Medicaid |
$12,226.07
|
| Rate for Payer: Kentucky WC Medicaid |
$12,350.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,152.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,285.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,663.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.89
|
| Rate for Payer: PHCS Commercial |
$34,129.20
|
| Rate for Payer: United Healthcare All Payer |
$31,285.10
|
|
|
STENT TALENT AAA BIF 26*14*140
|
Facility
|
IP
|
$35,551.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.66 |
| Max. Negotiated Rate |
$34,129.20 |
| Rate for Payer: Aetna Commercial |
$27,374.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.98
|
| Rate for Payer: Cash Price |
$17,775.62
|
| Rate for Payer: Cigna Commercial |
$29,507.54
|
| Rate for Payer: First Health Commercial |
$33,773.69
|
| Rate for Payer: Humana Commercial |
$30,218.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,152.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,285.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,663.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.89
|
| Rate for Payer: PHCS Commercial |
$34,129.20
|
| Rate for Payer: United Healthcare All Payer |
$31,285.10
|
|
|
STENT TALENT AAA BIF 28*14*140
|
Facility
|
OP
|
$35,551.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.66 |
| Max. Negotiated Rate |
$34,129.20 |
| Rate for Payer: Aetna Commercial |
$27,374.46
|
| Rate for Payer: Anthem Medicaid |
$12,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.98
|
| Rate for Payer: Cash Price |
$17,775.62
|
| Rate for Payer: Cigna Commercial |
$29,507.54
|
| Rate for Payer: First Health Commercial |
$33,773.69
|
| Rate for Payer: Humana Commercial |
$30,218.56
|
| Rate for Payer: Humana KY Medicaid |
$12,226.07
|
| Rate for Payer: Kentucky WC Medicaid |
$12,350.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,152.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,285.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,663.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.89
|
| Rate for Payer: PHCS Commercial |
$34,129.20
|
| Rate for Payer: United Healthcare All Payer |
$31,285.10
|
|
|
STENT TALENT AAA BIF 28*14*140
|
Facility
|
IP
|
$35,551.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.66 |
| Max. Negotiated Rate |
$34,129.20 |
| Rate for Payer: Aetna Commercial |
$27,374.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,729.98
|
| Rate for Payer: Cash Price |
$17,775.62
|
| Rate for Payer: Cigna Commercial |
$29,507.54
|
| Rate for Payer: First Health Commercial |
$33,773.69
|
| Rate for Payer: Humana Commercial |
$30,218.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,152.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,236.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,665.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,285.10
|
| Rate for Payer: Ohio Health Group HMO |
$26,663.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,621.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,020.89
|
| Rate for Payer: PHCS Commercial |
$34,129.20
|
| Rate for Payer: United Healthcare All Payer |
$31,285.10
|
|
|
STENT TALENT AAA BIF 30*14*140
|
Facility
|
IP
|
$38,471.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,001.26 |
| Max. Negotiated Rate |
$36,932.40 |
| Rate for Payer: Aetna Commercial |
$29,622.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,007.58
|
| Rate for Payer: Cash Price |
$19,235.62
|
| Rate for Payer: Cigna Commercial |
$31,931.14
|
| Rate for Payer: First Health Commercial |
$36,547.69
|
| Rate for Payer: Humana Commercial |
$32,700.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,546.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,391.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,541.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,854.70
|
| Rate for Payer: Ohio Health Group HMO |
$28,853.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,001.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,926.09
|
| Rate for Payer: PHCS Commercial |
$36,932.40
|
| Rate for Payer: United Healthcare All Payer |
$33,854.70
|
|
|
STENT TALENT AAA BIF 30*14*140
|
Facility
|
OP
|
$38,471.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,001.26 |
| Max. Negotiated Rate |
$36,932.40 |
| Rate for Payer: Aetna Commercial |
$29,622.86
|
| Rate for Payer: Anthem Medicaid |
$13,230.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,007.58
|
| Rate for Payer: Cash Price |
$19,235.62
|
| Rate for Payer: Cigna Commercial |
$31,931.14
|
| Rate for Payer: First Health Commercial |
$36,547.69
|
| Rate for Payer: Humana Commercial |
$32,700.56
|
| Rate for Payer: Humana KY Medicaid |
$13,230.26
|
| Rate for Payer: Kentucky WC Medicaid |
$13,364.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,546.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,391.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,541.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,495.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,854.70
|
| Rate for Payer: Ohio Health Group HMO |
$28,853.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,001.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,926.09
|
| Rate for Payer: PHCS Commercial |
$36,932.40
|
| Rate for Payer: United Healthcare All Payer |
$33,854.70
|
|
|
STENT TALENT AAA BIF 32*14*155
|
Facility
|
IP
|
$38,471.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,001.26 |
| Max. Negotiated Rate |
$36,932.40 |
| Rate for Payer: Aetna Commercial |
$29,622.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,007.58
|
| Rate for Payer: Cash Price |
$19,235.62
|
| Rate for Payer: Cigna Commercial |
$31,931.14
|
| Rate for Payer: First Health Commercial |
$36,547.69
|
| Rate for Payer: Humana Commercial |
$32,700.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,546.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,391.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,541.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,854.70
|
| Rate for Payer: Ohio Health Group HMO |
$28,853.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,001.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,926.09
|
| Rate for Payer: PHCS Commercial |
$36,932.40
|
| Rate for Payer: United Healthcare All Payer |
$33,854.70
|
|
|
STENT TALENT AAA BIF 32*14*155
|
Facility
|
OP
|
$38,471.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,001.26 |
| Max. Negotiated Rate |
$36,932.40 |
| Rate for Payer: Aetna Commercial |
$29,622.86
|
| Rate for Payer: Anthem Medicaid |
$13,230.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,007.58
|
| Rate for Payer: Cash Price |
$19,235.62
|
| Rate for Payer: Cigna Commercial |
$31,931.14
|
| Rate for Payer: First Health Commercial |
$36,547.69
|
| Rate for Payer: Humana Commercial |
$32,700.56
|
| Rate for Payer: Humana KY Medicaid |
$13,230.26
|
| Rate for Payer: Kentucky WC Medicaid |
$13,364.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,546.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,391.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,541.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,495.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,854.70
|
| Rate for Payer: Ohio Health Group HMO |
$28,853.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,694.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,001.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,926.09
|
| Rate for Payer: PHCS Commercial |
$36,932.40
|
| Rate for Payer: United Healthcare All Payer |
$33,854.70
|
|
