|
STENT TALENT ILIAC EXT 12*8*75
|
Facility
|
OP
|
$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 Medicaid |
$7,016.85
|
| 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: Humana KY Medicaid |
$7,016.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,088.26
|
| 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: Molina Healthcare Medicaid |
$7,157.64
|
| 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
|
|
|
STENT TALNT AAA LIMB 14*24*105
|
Facility
|
IP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
STENT TALNT AAA LIMB 14*24*105
|
Facility
|
OP
|
$20,586.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.21 |
| Max. Negotiated Rate |
$19,762.80 |
| Rate for Payer: Aetna Commercial |
$15,851.41
|
| Rate for Payer: Anthem Medicaid |
$7,079.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,057.28
|
| Rate for Payer: Cash Price |
$10,293.12
|
| Rate for Payer: Cigna Commercial |
$17,086.59
|
| Rate for Payer: First Health Commercial |
$19,556.94
|
| Rate for Payer: Humana Commercial |
$17,498.31
|
| Rate for Payer: Humana KY Medicaid |
$7,079.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,151.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,880.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,192.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,175.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,221.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,115.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,439.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,117.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,381.74
|
| Rate for Payer: PHCS Commercial |
$19,762.80
|
| Rate for Payer: United Healthcare All Payer |
$18,115.90
|
|
|
STENT TALNT ILIAC EXT 14*14*80
|
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 TALNT ILIAC EXT 14*14*80
|
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 TALNT ILIAC EXT 16*16*80
|
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 TALNT ILIAC EXT 16*16*80
|
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 TALNT ILIAC EXT 18*16*80
|
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 TALNT ILIAC EXT 18*16*80
|
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 TALNT ILIAC EXT 18*18*80
|
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 TALNT ILIAC EXT 18*18*80
|
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 TALNT ILIAC EXT 20*20*79
|
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 TALNT ILIAC EXT 20*20*79
|
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 TRACH COV ULTRA 16MM*4CM
|
Facility
|
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem Medicaid |
$3,234.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Humana KY Medicaid |
$3,234.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,267.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,299.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
STENT TRACH COV ULTRA 16MM*4CM
|
Facility
|
IP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.84 |
| Max. Negotiated Rate |
$9,030.24 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
STENT TRACH COV ULTRA 16MM*6CM
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
STENT TRACH COV ULTRA 16MM*6CM
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
STENT TRACHEAL 18MM*4CM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 TRACHEAL 18MM*4CM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 TRACHEAL DUMON 12*40
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT TRACHEAL DUMON 12*40
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT TRACHEAL DUMON 14*40
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT TRACHEAL DUMON 14*40
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT TRACHEAL DUMON 14*50
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
STENT TRACHEAL DUMON 14*50
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
