|
STENT TRACHEAL ULTRA 12MM*3CM
|
Facility
|
OP
|
$8,599.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,117.89 |
| Max. Negotiated Rate |
$8,255.16 |
| Rate for Payer: Aetna Commercial |
$6,621.32
|
| Rate for Payer: Anthem Medicaid |
$2,957.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,707.31
|
| Rate for Payer: Cash Price |
$4,299.56
|
| Rate for Payer: Cigna Commercial |
$7,137.27
|
| Rate for Payer: First Health Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial |
$7,309.25
|
| Rate for Payer: Humana KY Medicaid |
$2,957.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,987.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,051.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,346.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,579.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,016.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,567.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,449.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,719.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,665.73
|
| Rate for Payer: PHCS Commercial |
$8,255.16
|
| Rate for Payer: United Healthcare All Payer |
$7,567.23
|
|
|
STENT TRACHEAL ULTRA 12MM*3CM
|
Facility
|
IP
|
$8,599.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,117.89 |
| Max. Negotiated Rate |
$8,255.16 |
| Rate for Payer: Aetna Commercial |
$6,621.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,707.31
|
| Rate for Payer: Cash Price |
$4,299.56
|
| Rate for Payer: Cigna Commercial |
$7,137.27
|
| Rate for Payer: First Health Commercial |
$8,169.16
|
| Rate for Payer: Humana Commercial |
$7,309.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,051.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,346.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,579.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,567.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,449.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,719.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,665.73
|
| Rate for Payer: PHCS Commercial |
$8,255.16
|
| Rate for Payer: United Healthcare All Payer |
$7,567.23
|
|
|
STENT TRACHEAL ULTRA 16MM*8CM
|
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 ULTRA 16MM*8CM
|
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 ULTRA 18MM*6CM
|
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 ULTRA 18MM*6CM
|
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 ULTRA 18MM*8CM
|
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 ULTRA 18MM*8CM
|
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 ULTRA 20MM*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 ULTRA 20MM*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 ULTRA 20MM*6CM
|
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 ULTRA 20MM*6CM
|
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 ULTRA 20MM*8CM
|
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 ULTRA 20MM*8CM
|
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 TRACH ULTRA COV 14MM*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 ULTRA COV 14MM*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 ULTRA COV 14MM*6CM
|
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 ULTRA COV 14MM*6CM
|
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 ULTRAFLEX BRONCH 10*20
|
Facility
|
IP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.26 |
| Max. Negotiated Rate |
$9,660.96 |
| Rate for Payer: Aetna Commercial |
$7,748.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.53
|
| Rate for Payer: Cash Price |
$5,031.75
|
| Rate for Payer: Cigna Commercial |
$8,352.70
|
| Rate for Payer: First Health Commercial |
$9,560.32
|
| Rate for Payer: Humana Commercial |
$8,553.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,252.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,119.68
|
| Rate for Payer: PHCS Commercial |
$9,660.96
|
| Rate for Payer: United Healthcare All Payer |
$8,855.88
|
|
|
STENT ULTRAFLEX BRONCH 10*20
|
Facility
|
OP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.26 |
| Max. Negotiated Rate |
$9,660.96 |
| Rate for Payer: Aetna Commercial |
$7,748.90
|
| Rate for Payer: Anthem Medicaid |
$3,460.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.53
|
| Rate for Payer: Cash Price |
$5,031.75
|
| Rate for Payer: Cigna Commercial |
$8,352.70
|
| Rate for Payer: First Health Commercial |
$9,560.32
|
| Rate for Payer: Humana Commercial |
$8,553.98
|
| Rate for Payer: Humana KY Medicaid |
$3,460.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,496.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,252.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,530.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,119.68
|
| Rate for Payer: PHCS Commercial |
$9,660.96
|
| Rate for Payer: United Healthcare All Payer |
$8,855.88
|
|
|
STENT ULTRAFLEX BRONCH 10*30
|
Facility
|
IP
|
$9,132.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.26 |
| Max. Negotiated Rate |
$8,767.44 |
| Rate for Payer: Aetna Commercial |
$7,032.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,123.54
|
| Rate for Payer: Cash Price |
$4,566.38
|
| Rate for Payer: Cigna Commercial |
$7,580.18
|
| Rate for Payer: First Health Commercial |
$8,676.11
|
| Rate for Payer: Humana Commercial |
$7,762.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.15
|
| Rate for Payer: PHCS Commercial |
$8,767.44
|
| Rate for Payer: United Healthcare All Payer |
$8,036.82
|
|
|
STENT ULTRAFLEX BRONCH 10*30
|
Facility
|
OP
|
$9,132.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.26 |
| Max. Negotiated Rate |
$8,767.44 |
| Rate for Payer: Aetna Commercial |
$7,032.22
|
| Rate for Payer: Anthem Medicaid |
$3,140.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,123.54
|
| Rate for Payer: Cash Price |
$4,566.38
|
| Rate for Payer: Cigna Commercial |
$7,580.18
|
| Rate for Payer: First Health Commercial |
$8,676.11
|
| Rate for Payer: Humana Commercial |
$7,762.84
|
| Rate for Payer: Humana KY Medicaid |
$3,140.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.15
|
| Rate for Payer: PHCS Commercial |
$8,767.44
|
| Rate for Payer: United Healthcare All Payer |
$8,036.82
|
|
|
STENT ULTRAFLEX BRONCH 12*20
|
Facility
|
IP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.26 |
| Max. Negotiated Rate |
$9,660.96 |
| Rate for Payer: Aetna Commercial |
$7,748.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.53
|
| Rate for Payer: Cash Price |
$5,031.75
|
| Rate for Payer: Cigna Commercial |
$8,352.70
|
| Rate for Payer: First Health Commercial |
$9,560.32
|
| Rate for Payer: Humana Commercial |
$8,553.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,252.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,119.68
|
| Rate for Payer: PHCS Commercial |
$9,660.96
|
| Rate for Payer: United Healthcare All Payer |
$8,855.88
|
|
|
STENT ULTRAFLEX BRONCH 12*20
|
Facility
|
OP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.26 |
| Max. Negotiated Rate |
$9,660.96 |
| Rate for Payer: Aetna Commercial |
$7,748.90
|
| Rate for Payer: Anthem Medicaid |
$3,460.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.53
|
| Rate for Payer: Cash Price |
$5,031.75
|
| Rate for Payer: Cigna Commercial |
$8,352.70
|
| Rate for Payer: First Health Commercial |
$9,560.32
|
| Rate for Payer: Humana Commercial |
$8,553.98
|
| Rate for Payer: Humana KY Medicaid |
$3,460.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,496.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,252.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,530.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,119.68
|
| Rate for Payer: PHCS Commercial |
$9,660.96
|
| Rate for Payer: United Healthcare All Payer |
$8,855.88
|
|
|
STENT ULTRAFLEX BRONCH 12*40
|
Facility
|
IP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.26 |
| Max. Negotiated Rate |
$9,660.96 |
| Rate for Payer: Aetna Commercial |
$7,748.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,849.53
|
| Rate for Payer: Cash Price |
$5,031.75
|
| Rate for Payer: Cigna Commercial |
$8,352.70
|
| Rate for Payer: First Health Commercial |
$9,560.32
|
| Rate for Payer: Humana Commercial |
$8,553.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,252.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,426.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,855.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,547.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,119.68
|
| Rate for Payer: PHCS Commercial |
$9,660.96
|
| Rate for Payer: United Healthcare All Payer |
$8,855.88
|
|
