|
STENT TALENT AAA BIF 32*20*170
|
Facility
|
OP
|
$38,653.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,024.99 |
| Max. Negotiated Rate |
$37,107.60 |
| Rate for Payer: Aetna Commercial |
$29,763.39
|
| Rate for Payer: Anthem Medicaid |
$13,293.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,149.92
|
| Rate for Payer: Cash Price |
$19,326.88
|
| Rate for Payer: Cigna Commercial |
$32,082.61
|
| Rate for Payer: First Health Commercial |
$36,721.06
|
| Rate for Payer: Humana Commercial |
$32,855.69
|
| Rate for Payer: Humana KY Medicaid |
$13,293.02
|
| Rate for Payer: Kentucky WC Medicaid |
$13,428.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,696.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,526.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,596.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,559.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,015.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,990.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,730.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,024.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,982.66
|
| Rate for Payer: PHCS Commercial |
$37,107.60
|
| Rate for Payer: United Healthcare All Payer |
$34,015.30
|
|
|
STENT TALENT AAA BIF 32*20*170
|
Facility
|
IP
|
$38,653.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,024.99 |
| Max. Negotiated Rate |
$37,107.60 |
| Rate for Payer: Aetna Commercial |
$29,763.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,149.92
|
| Rate for Payer: Cash Price |
$19,326.88
|
| Rate for Payer: Cigna Commercial |
$32,082.61
|
| Rate for Payer: First Health Commercial |
$36,721.06
|
| Rate for Payer: Humana Commercial |
$32,855.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,696.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,526.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,596.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,015.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,990.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,730.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,024.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,982.66
|
| Rate for Payer: PHCS Commercial |
$37,107.60
|
| Rate for Payer: United Healthcare All Payer |
$34,015.30
|
|
|
STENT TALENT AAA BIF 34*16*155
|
Facility
|
IP
|
$37,741.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,906.36 |
| Max. Negotiated Rate |
$36,231.60 |
| Rate for Payer: Aetna Commercial |
$29,060.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,438.18
|
| Rate for Payer: Cash Price |
$18,870.62
|
| Rate for Payer: Cigna Commercial |
$31,325.24
|
| Rate for Payer: First Health Commercial |
$35,854.19
|
| Rate for Payer: Humana Commercial |
$32,080.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,947.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,853.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,322.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,212.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,305.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,548.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,699.79
|
| Rate for Payer: PHCS Commercial |
$36,231.60
|
| Rate for Payer: United Healthcare All Payer |
$33,212.30
|
|
|
STENT TALENT AAA BIF 34*16*155
|
Facility
|
OP
|
$37,741.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,906.36 |
| Max. Negotiated Rate |
$36,231.60 |
| Rate for Payer: Aetna Commercial |
$29,060.76
|
| Rate for Payer: Anthem Medicaid |
$12,979.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,438.18
|
| Rate for Payer: Cash Price |
$18,870.62
|
| Rate for Payer: Cigna Commercial |
$31,325.24
|
| Rate for Payer: First Health Commercial |
$35,854.19
|
| Rate for Payer: Humana Commercial |
$32,080.06
|
| Rate for Payer: Humana KY Medicaid |
$12,979.22
|
| Rate for Payer: Kentucky WC Medicaid |
$13,111.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,947.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,853.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,322.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,239.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,212.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,305.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,548.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,699.79
|
| Rate for Payer: PHCS Commercial |
$36,231.60
|
| Rate for Payer: United Healthcare All Payer |
$33,212.30
|
|
|
STENT TALENT AAA BIF 34*18*170
|
Facility
|
IP
|
$39,657.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,155.48 |
| Max. Negotiated Rate |
$38,071.20 |
| Rate for Payer: Aetna Commercial |
$30,536.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,932.85
|
| Rate for Payer: Cash Price |
$19,828.75
|
| Rate for Payer: Cigna Commercial |
$32,915.72
|
| Rate for Payer: First Health Commercial |
$37,674.62
|
| Rate for Payer: Humana Commercial |
$33,708.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,519.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,267.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,897.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,898.60
|
| Rate for Payer: Ohio Health Group HMO |
$29,743.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,931.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,155.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,293.82
|
| Rate for Payer: PHCS Commercial |
$38,071.20
|
| Rate for Payer: United Healthcare All Payer |
$34,898.60
|
|
|
STENT TALENT AAA BIF 34*18*170
|
Facility
|
OP
|
$39,657.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,155.48 |
| Max. Negotiated Rate |
$38,071.20 |
| Rate for Payer: Aetna Commercial |
$30,536.28
|
| Rate for Payer: Anthem Medicaid |
$13,638.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,932.85
|
| Rate for Payer: Cash Price |
$19,828.75
|
| Rate for Payer: Cigna Commercial |
$32,915.72
|
| Rate for Payer: First Health Commercial |
$37,674.62
|
| Rate for Payer: Humana Commercial |
$33,708.88
|
| Rate for Payer: Humana KY Medicaid |
$13,638.21
|
| Rate for Payer: Kentucky WC Medicaid |
$13,777.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,519.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,267.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,897.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,911.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,898.60
|
| Rate for Payer: Ohio Health Group HMO |
$29,743.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,931.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,155.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,293.82
|
| Rate for Payer: PHCS Commercial |
$38,071.20
|
| Rate for Payer: United Healthcare All Payer |
$34,898.60
|
|
|
STENT TALENT AAA BIF 36*18*155
|
Facility
|
IP
|
$37,741.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,906.36 |
| Max. Negotiated Rate |
$36,231.60 |
| Rate for Payer: Aetna Commercial |
$29,060.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,438.18
|
| Rate for Payer: Cash Price |
$18,870.62
|
| Rate for Payer: Cigna Commercial |
$31,325.24
|
| Rate for Payer: First Health Commercial |
$35,854.19
|
| Rate for Payer: Humana Commercial |
$32,080.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,947.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,853.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,322.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,212.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,305.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,548.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,699.79
|
| Rate for Payer: PHCS Commercial |
$36,231.60
|
| Rate for Payer: United Healthcare All Payer |
$33,212.30
|
|
|
STENT TALENT AAA BIF 36*18*155
|
Facility
|
OP
|
$37,741.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,906.36 |
| Max. Negotiated Rate |
$36,231.60 |
| Rate for Payer: Aetna Commercial |
$29,060.76
|
| Rate for Payer: Anthem Medicaid |
$12,979.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,438.18
|
| Rate for Payer: Cash Price |
$18,870.62
|
| Rate for Payer: Cigna Commercial |
$31,325.24
|
| Rate for Payer: First Health Commercial |
$35,854.19
|
| Rate for Payer: Humana Commercial |
$32,080.06
|
| Rate for Payer: Humana KY Medicaid |
$12,979.22
|
| Rate for Payer: Kentucky WC Medicaid |
$13,111.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,947.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,853.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,322.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,239.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,212.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,305.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,548.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,906.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,699.79
|
| Rate for Payer: PHCS Commercial |
$36,231.60
|
| Rate for Payer: United Healthcare All Payer |
$33,212.30
|
|
|
STENT TALENT AAA LIMB 14*14*75
|
Facility
|
IP
|
$17,070.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,219.10 |
| Max. Negotiated Rate |
$16,387.20 |
| Rate for Payer: Aetna Commercial |
$13,143.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,314.60
|
| Rate for Payer: Cash Price |
$8,535.00
|
| Rate for Payer: Cigna Commercial |
$14,168.10
|
| Rate for Payer: First Health Commercial |
$16,216.50
|
| Rate for Payer: Humana Commercial |
$14,509.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,997.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,597.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,121.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,021.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,414.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,219.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,291.70
|
| Rate for Payer: PHCS Commercial |
$16,387.20
|
| Rate for Payer: United Healthcare All Payer |
$15,021.60
|
|
|
STENT TALENT AAA LIMB 14*14*75
|
Facility
|
OP
|
$17,070.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,219.10 |
| Max. Negotiated Rate |
$16,387.20 |
| Rate for Payer: Aetna Commercial |
$13,143.90
|
| Rate for Payer: Anthem Medicaid |
$5,870.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,314.60
|
| Rate for Payer: Cash Price |
$8,535.00
|
| Rate for Payer: Cigna Commercial |
$14,168.10
|
| Rate for Payer: First Health Commercial |
$16,216.50
|
| Rate for Payer: Humana Commercial |
$14,509.50
|
| Rate for Payer: Humana KY Medicaid |
$5,870.37
|
| Rate for Payer: Kentucky WC Medicaid |
$5,930.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,997.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,597.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,121.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,988.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,021.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,414.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,219.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,291.70
|
| Rate for Payer: PHCS Commercial |
$16,387.20
|
| Rate for Payer: United Healthcare All Payer |
$15,021.60
|
|
|
STENT TALENT AAA LIMB 14*16*75
|
Facility
|
OP
|
$17,790.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,312.70 |
| Max. Negotiated Rate |
$17,078.40 |
| Rate for Payer: Aetna Commercial |
$13,698.30
|
| Rate for Payer: Anthem Medicaid |
$6,117.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,876.20
|
| Rate for Payer: Cash Price |
$8,895.00
|
| Rate for Payer: Cigna Commercial |
$14,765.70
|
| Rate for Payer: First Health Commercial |
$16,900.50
|
| Rate for Payer: Humana Commercial |
$15,121.50
|
| Rate for Payer: Humana KY Medicaid |
$6,117.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,180.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,587.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,129.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,337.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,240.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,655.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,312.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,514.90
|
| Rate for Payer: PHCS Commercial |
$17,078.40
|
| Rate for Payer: United Healthcare All Payer |
$15,655.20
|
|
|
STENT TALENT AAA LIMB 14*16*75
|
Facility
|
IP
|
$17,790.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,312.70 |
| Max. Negotiated Rate |
$17,078.40 |
| Rate for Payer: Aetna Commercial |
$13,698.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,876.20
|
| Rate for Payer: Cash Price |
$8,895.00
|
| Rate for Payer: Cigna Commercial |
$14,765.70
|
| Rate for Payer: First Health Commercial |
$16,900.50
|
| Rate for Payer: Humana Commercial |
$15,121.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,587.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,129.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,337.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,655.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,312.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,514.90
|
| Rate for Payer: PHCS Commercial |
$17,078.40
|
| Rate for Payer: United Healthcare All Payer |
$15,655.20
|
|
|
STENT TALENT AAA LIMB 14*18*75
|
Facility
|
IP
|
$18,330.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.90 |
| Max. Negotiated Rate |
$17,596.80 |
| Rate for Payer: Aetna Commercial |
$14,114.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,297.40
|
| Rate for Payer: Cash Price |
$9,165.00
|
| Rate for Payer: Cigna Commercial |
$15,213.90
|
| Rate for Payer: First Health Commercial |
$17,413.50
|
| Rate for Payer: Humana Commercial |
$15,580.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,030.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,527.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,382.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.30
|
| Rate for Payer: PHCS Commercial |
$17,596.80
|
| Rate for Payer: United Healthcare All Payer |
$16,130.40
|
|
|
STENT TALENT AAA LIMB 14*18*75
|
Facility
|
OP
|
$18,330.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.90 |
| Max. Negotiated Rate |
$17,596.80 |
| Rate for Payer: Aetna Commercial |
$14,114.10
|
| Rate for Payer: Anthem Medicaid |
$6,303.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,297.40
|
| Rate for Payer: Cash Price |
$9,165.00
|
| Rate for Payer: Cigna Commercial |
$15,213.90
|
| Rate for Payer: First Health Commercial |
$17,413.50
|
| Rate for Payer: Humana Commercial |
$15,580.50
|
| Rate for Payer: Humana KY Medicaid |
$6,303.69
|
| Rate for Payer: Kentucky WC Medicaid |
$6,367.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,030.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,527.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,430.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,382.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.30
|
| Rate for Payer: PHCS Commercial |
$17,596.80
|
| Rate for Payer: United Healthcare All Payer |
$16,130.40
|
|
|
STENT TALENT AAA LIMB 14*20*75
|
Facility
|
IP
|
$18,330.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.90 |
| Max. Negotiated Rate |
$17,596.80 |
| Rate for Payer: Aetna Commercial |
$14,114.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,297.40
|
| Rate for Payer: Cash Price |
$9,165.00
|
| Rate for Payer: Cigna Commercial |
$15,213.90
|
| Rate for Payer: First Health Commercial |
$17,413.50
|
| Rate for Payer: Humana Commercial |
$15,580.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,030.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,527.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,382.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.30
|
| Rate for Payer: PHCS Commercial |
$17,596.80
|
| Rate for Payer: United Healthcare All Payer |
$16,130.40
|
|
|
STENT TALENT AAA LIMB 14*20*75
|
Facility
|
OP
|
$18,330.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,382.90 |
| Max. Negotiated Rate |
$17,596.80 |
| Rate for Payer: Aetna Commercial |
$14,114.10
|
| Rate for Payer: Anthem Medicaid |
$6,303.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,297.40
|
| Rate for Payer: Cash Price |
$9,165.00
|
| Rate for Payer: Cigna Commercial |
$15,213.90
|
| Rate for Payer: First Health Commercial |
$17,413.50
|
| Rate for Payer: Humana Commercial |
$15,580.50
|
| Rate for Payer: Humana KY Medicaid |
$6,303.69
|
| Rate for Payer: Kentucky WC Medicaid |
$6,367.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,030.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,527.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,430.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,130.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,382.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.30
|
| Rate for Payer: PHCS Commercial |
$17,596.80
|
| Rate for Payer: United Healthcare All Payer |
$16,130.40
|
|
|
STENT TALENT AORTCEXT 28*28*29
|
Facility
|
IP
|
$13,793.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,793.19 |
| Max. Negotiated Rate |
$13,242.00 |
| Rate for Payer: Aetna Commercial |
$10,621.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,759.12
|
| Rate for Payer: Cash Price |
$6,896.88
|
| Rate for Payer: Cigna Commercial |
$11,448.81
|
| Rate for Payer: First Health Commercial |
$13,104.06
|
| Rate for Payer: Humana Commercial |
$11,724.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,310.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,179.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,138.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,138.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,345.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,758.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,793.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,276.06
|
| Rate for Payer: PHCS Commercial |
$13,242.00
|
| Rate for Payer: United Healthcare All Payer |
$12,138.50
|
|
|
STENT TALENT AORTCEXT 28*28*29
|
Facility
|
OP
|
$13,793.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,793.19 |
| Max. Negotiated Rate |
$13,242.00 |
| Rate for Payer: Aetna Commercial |
$10,621.19
|
| Rate for Payer: Anthem Medicaid |
$4,743.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,759.12
|
| Rate for Payer: Cash Price |
$6,896.88
|
| Rate for Payer: Cigna Commercial |
$11,448.81
|
| Rate for Payer: First Health Commercial |
$13,104.06
|
| Rate for Payer: Humana Commercial |
$11,724.69
|
| Rate for Payer: Humana KY Medicaid |
$4,743.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,791.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,310.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,179.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,138.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,138.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,345.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,758.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,793.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,276.06
|
| Rate for Payer: PHCS Commercial |
$13,242.00
|
| Rate for Payer: United Healthcare All Payer |
$12,138.50
|
|
|
STENT TALENT AORTCEXT 32*32*28
|
Facility
|
IP
|
$15,630.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.90 |
| Max. Negotiated Rate |
$15,004.80 |
| Rate for Payer: Aetna Commercial |
$12,035.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.40
|
| Rate for Payer: Cash Price |
$7,815.00
|
| Rate for Payer: Cigna Commercial |
$12,972.90
|
| Rate for Payer: First Health Commercial |
$14,848.50
|
| Rate for Payer: Humana Commercial |
$13,285.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,689.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,031.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.30
|
| Rate for Payer: PHCS Commercial |
$15,004.80
|
| Rate for Payer: United Healthcare All Payer |
$13,754.40
|
|
|
STENT TALENT AORTCEXT 32*32*28
|
Facility
|
OP
|
$15,630.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.90 |
| Max. Negotiated Rate |
$15,004.80 |
| Rate for Payer: Aetna Commercial |
$12,035.10
|
| Rate for Payer: Anthem Medicaid |
$5,375.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.40
|
| Rate for Payer: Cash Price |
$7,815.00
|
| Rate for Payer: Cigna Commercial |
$12,972.90
|
| Rate for Payer: First Health Commercial |
$14,848.50
|
| Rate for Payer: Humana Commercial |
$13,285.50
|
| Rate for Payer: Humana KY Medicaid |
$5,375.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5,429.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,689.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,483.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,031.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.30
|
| Rate for Payer: PHCS Commercial |
$15,004.80
|
| Rate for Payer: United Healthcare All Payer |
$13,754.40
|
|
|
STENT TALENT AORTCEXT 36*36*26
|
Facility
|
IP
|
$17,430.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.90 |
| Max. Negotiated Rate |
$16,732.80 |
| Rate for Payer: Aetna Commercial |
$13,421.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,595.40
|
| Rate for Payer: Cash Price |
$8,715.00
|
| Rate for Payer: Cigna Commercial |
$14,466.90
|
| Rate for Payer: First Health Commercial |
$16,558.50
|
| Rate for Payer: Humana Commercial |
$14,815.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,292.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,229.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.30
|
| Rate for Payer: PHCS Commercial |
$16,732.80
|
| Rate for Payer: United Healthcare All Payer |
$15,338.40
|
|
|
STENT TALENT AORTCEXT 36*36*26
|
Facility
|
OP
|
$17,430.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.90 |
| Max. Negotiated Rate |
$16,732.80 |
| Rate for Payer: Aetna Commercial |
$13,421.10
|
| Rate for Payer: Anthem Medicaid |
$5,994.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,595.40
|
| Rate for Payer: Cash Price |
$8,715.00
|
| Rate for Payer: Cigna Commercial |
$14,466.90
|
| Rate for Payer: First Health Commercial |
$16,558.50
|
| Rate for Payer: Humana Commercial |
$14,815.50
|
| Rate for Payer: Humana KY Medicaid |
$5,994.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,055.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,292.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,863.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,229.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,114.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.30
|
| Rate for Payer: PHCS Commercial |
$16,732.80
|
| Rate for Payer: United Healthcare All Payer |
$15,338.40
|
|
|
STENT TALENT CON LIMB 14*16*90
|
Facility
|
IP
|
$18,510.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.30 |
| Max. Negotiated Rate |
$17,769.60 |
| Rate for Payer: Aetna Commercial |
$14,252.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,437.80
|
| Rate for Payer: Cash Price |
$9,255.00
|
| Rate for Payer: Cigna Commercial |
$15,363.30
|
| Rate for Payer: First Health Commercial |
$17,584.50
|
| Rate for Payer: Humana Commercial |
$15,733.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,178.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,660.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,553.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,288.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,882.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,702.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,406.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.10
|
| Rate for Payer: PHCS Commercial |
$17,769.60
|
| Rate for Payer: United Healthcare All Payer |
$16,288.80
|
|
|
STENT TALENT CON LIMB 14*16*90
|
Facility
|
OP
|
$18,510.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.30 |
| Max. Negotiated Rate |
$17,769.60 |
| Rate for Payer: Aetna Commercial |
$14,252.70
|
| Rate for Payer: Anthem Medicaid |
$6,365.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,437.80
|
| Rate for Payer: Cash Price |
$9,255.00
|
| Rate for Payer: Cigna Commercial |
$15,363.30
|
| Rate for Payer: First Health Commercial |
$17,584.50
|
| Rate for Payer: Humana Commercial |
$15,733.50
|
| Rate for Payer: Humana KY Medicaid |
$6,365.59
|
| Rate for Payer: Kentucky WC Medicaid |
$6,430.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,178.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,660.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,553.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,493.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,288.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,882.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,702.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,406.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.10
|
| Rate for Payer: PHCS Commercial |
$17,769.60
|
| Rate for Payer: United Healthcare All Payer |
$16,288.80
|
|
|
STENT TALENT ILIAC EXT 12*8*75
|
Facility
|
IP
|
$20,403.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.49 |
| Max. Negotiated Rate |
$19,587.60 |
| Rate for Payer: Aetna Commercial |
$15,710.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,914.92
|
| Rate for Payer: Cash Price |
$10,201.88
|
| Rate for Payer: Cigna Commercial |
$16,935.11
|
| Rate for Payer: First Health Commercial |
$19,383.56
|
| Rate for Payer: Humana Commercial |
$17,343.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,731.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,057.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,121.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,955.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.16
|
| Rate for Payer: PHCS Commercial |
$19,587.60
|
| Rate for Payer: United Healthcare All Payer |
$17,955.30
|
|
