|
STENT ULTRAFLX BRONCHIAL 14*20
|
Facility
|
IP
|
$9,132.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 ULTRAFLX BRONCHIAL 14*20
|
Facility
|
OP
|
$9,132.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 ULTRAFLX PROX 10-2*16*95
|
Facility
|
OP
|
$12,384.85
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.03 |
| Max. Negotiated Rate |
$11,889.46 |
| Rate for Payer: Aetna Commercial |
$9,536.33
|
| Rate for Payer: Anthem Medicaid |
$4,259.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,660.18
|
| Rate for Payer: Cash Price |
$6,192.42
|
| Rate for Payer: Cigna Commercial |
$10,279.43
|
| Rate for Payer: First Health Commercial |
$11,765.61
|
| Rate for Payer: Humana Commercial |
$10,527.12
|
| Rate for Payer: Humana KY Medicaid |
$4,259.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,302.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,155.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,140.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,715.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,344.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,898.67
|
| Rate for Payer: Ohio Health Group HMO |
$9,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,839.30
|
| Rate for Payer: PHCS Commercial |
$11,889.46
|
| Rate for Payer: United Healthcare All Payer |
$10,898.67
|
|
|
STENT ULTRAFLX PROX 10-2*16*95
|
Facility
|
IP
|
$12,384.85
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.03 |
| Max. Negotiated Rate |
$11,889.46 |
| Rate for Payer: Aetna Commercial |
$9,536.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,660.18
|
| Rate for Payer: Cash Price |
$6,192.42
|
| Rate for Payer: Cigna Commercial |
$10,279.43
|
| Rate for Payer: First Health Commercial |
$11,765.61
|
| Rate for Payer: Humana Commercial |
$10,527.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,155.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,140.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,715.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,898.67
|
| Rate for Payer: Ohio Health Group HMO |
$9,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,839.30
|
| Rate for Payer: PHCS Commercial |
$11,889.46
|
| Rate for Payer: United Healthcare All Payer |
$10,898.67
|
|
|
STENT ULTRFLX BRONCH 10*30 COV
|
Facility
|
OP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 10*30 COV
|
Facility
|
IP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 12*30 COV
|
Facility
|
OP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 12*30 COV
|
Facility
|
IP
|
$10,063.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 14*30 COV
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
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 ULTRFLX BRONCH 14*30 COV
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
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 ULTRFLX TRACH 14*40 PROX
|
Facility
|
OP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem Medicaid |
$3,272.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Humana KY Medicaid |
$3,272.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,338.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
STENT ULTRFLX TRACH 14*40 PROX
|
Facility
|
IP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
STENT UNI PLUS 11 FR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT UNI PLUS 11 FR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT VIABAHN 6MM*10CM
|
Facility
|
IP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
STENT VIABAHN 6MM*10CM
|
Facility
|
OP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem Medicaid |
$4,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Humana KY Medicaid |
$4,141.16
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
STENT VIABAHN 6MM*15CM
|
Facility
|
OP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem Medicaid |
$4,643.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Humana KY Medicaid |
$4,643.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,690.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,736.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
STENT VIABAHN 6MM*15CM
|
Facility
|
IP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
STENT VIABAHN 6MM*5CM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
STENT VIABAHN 6MM*5CM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
STENT VIABAHN 7MM*10CM
|
Facility
|
IP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
STENT VIABAHN 7MM*10CM
|
Facility
|
OP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem Medicaid |
$4,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Humana KY Medicaid |
$4,141.16
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
STENT VIABAHN 7MM*15CM
|
Facility
|
IP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
STENT VIABAHN 7MM*15CM
|
Facility
|
OP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem Medicaid |
$4,643.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Humana KY Medicaid |
$4,643.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,690.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,736.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
STENT VIABAHN 7MM*5MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
