|
STENT VIABAHN 7MM*5MM
|
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 8MM*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 8MM*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 8MM*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 8MM*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 8MM*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 8MM*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 WALFLX BIL COV 10MM*80MM
|
Facility
|
IP
|
$13,645.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.89 |
| Max. Negotiated Rate |
$13,099.49 |
| Rate for Payer: Aetna Commercial |
$10,506.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,643.33
|
| Rate for Payer: Cash Price |
$6,822.65
|
| Rate for Payer: Cigna Commercial |
$11,325.60
|
| Rate for Payer: First Health Commercial |
$12,963.04
|
| Rate for Payer: Humana Commercial |
$11,598.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,189.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,070.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,093.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,007.86
|
| Rate for Payer: Ohio Health Group HMO |
$10,233.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,729.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,230.04
|
| Rate for Payer: PHCS Commercial |
$13,099.49
|
| Rate for Payer: United Healthcare All Payer |
$12,007.86
|
|
|
STENT WALFLX BIL COV 10MM*80MM
|
Facility
|
OP
|
$13,645.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.89 |
| Max. Negotiated Rate |
$13,099.49 |
| Rate for Payer: Aetna Commercial |
$10,506.88
|
| Rate for Payer: Anthem Medicaid |
$4,692.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,643.33
|
| Rate for Payer: Cash Price |
$6,822.65
|
| Rate for Payer: Cigna Commercial |
$11,325.60
|
| Rate for Payer: First Health Commercial |
$12,963.04
|
| Rate for Payer: Humana Commercial |
$11,598.50
|
| Rate for Payer: Humana KY Medicaid |
$4,692.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,740.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,189.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,070.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,093.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,786.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,007.86
|
| Rate for Payer: Ohio Health Group HMO |
$10,233.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,729.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,230.04
|
| Rate for Payer: PHCS Commercial |
$13,099.49
|
| Rate for Payer: United Healthcare All Payer |
$12,007.86
|
|
|
STENT WALFLX BIL COVERED 10*60
|
Facility
|
OP
|
$12,844.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.82 |
| Max. Negotiated Rate |
$12,330.96 |
| Rate for Payer: Aetna Commercial |
$9,890.46
|
| Rate for Payer: Anthem Medicaid |
$4,417.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,018.90
|
| Rate for Payer: Cash Price |
$6,422.38
|
| Rate for Payer: Cigna Commercial |
$10,661.14
|
| Rate for Payer: First Health Commercial |
$12,202.51
|
| Rate for Payer: Humana Commercial |
$10,918.04
|
| Rate for Payer: Humana KY Medicaid |
$4,417.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,532.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,479.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,505.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,303.38
|
| Rate for Payer: Ohio Health Group HMO |
$9,633.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,981.87
|
| Rate for Payer: PHCS Commercial |
$12,330.96
|
| Rate for Payer: United Healthcare All Payer |
$11,303.38
|
|
|
STENT WALFLX BIL COVERED 10*60
|
Facility
|
IP
|
$12,844.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.82 |
| Max. Negotiated Rate |
$12,330.96 |
| Rate for Payer: Aetna Commercial |
$9,890.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,018.90
|
| Rate for Payer: Cash Price |
$6,422.38
|
| Rate for Payer: Cigna Commercial |
$10,661.14
|
| Rate for Payer: First Health Commercial |
$12,202.51
|
| Rate for Payer: Humana Commercial |
$10,918.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,532.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,479.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,303.38
|
| Rate for Payer: Ohio Health Group HMO |
$9,633.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,981.87
|
| Rate for Payer: PHCS Commercial |
$12,330.96
|
| Rate for Payer: United Healthcare All Payer |
$11,303.38
|
|
|
STENT WALFLX BIL TRANSHEP 8*60
|
Facility
|
OP
|
$15,536.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,019.73 |
| Max. Negotiated Rate |
$14,914.94 |
| Rate for Payer: Aetna Commercial |
$11,963.03
|
| Rate for Payer: Anthem Medicaid |
$5,342.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,118.39
|
| Rate for Payer: Cash Price |
$7,768.20
|
| Rate for Payer: Cigna Commercial |
$12,895.21
|
| Rate for Payer: First Health Commercial |
$14,759.58
|
| Rate for Payer: Humana Commercial |
$13,205.94
|
| Rate for Payer: Humana KY Medicaid |
$5,342.97
|
| Rate for Payer: Kentucky WC Medicaid |
$5,397.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,739.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,465.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,660.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,450.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,672.03
|
| Rate for Payer: Ohio Health Group HMO |
$11,652.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,107.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,019.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,816.28
|
| Rate for Payer: PHCS Commercial |
$14,914.94
|
| Rate for Payer: United Healthcare All Payer |
$13,672.03
|
|
|
STENT WALFLX BIL TRANSHEP 8*60
|
Facility
|
IP
|
$15,536.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,019.73 |
| Max. Negotiated Rate |
$14,914.94 |
| Rate for Payer: Aetna Commercial |
$11,963.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,118.39
|
| Rate for Payer: Cash Price |
$7,768.20
|
| Rate for Payer: Cigna Commercial |
$12,895.21
|
| Rate for Payer: First Health Commercial |
$14,759.58
|
| Rate for Payer: Humana Commercial |
$13,205.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,739.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,465.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,660.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,672.03
|
| Rate for Payer: Ohio Health Group HMO |
$11,652.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,107.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,019.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,816.28
|
| Rate for Payer: PHCS Commercial |
$14,914.94
|
| Rate for Payer: United Healthcare All Payer |
$13,672.03
|
|
|
STENT WALL 10MM*20MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 10MM*20MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 10MM*39MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 10MM*39MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 12MM*20MM
|
Facility
|
OP
|
$6,506.79
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$6,246.52 |
| Rate for Payer: Aetna Commercial |
$5,010.23
|
| Rate for Payer: Anthem Medicaid |
$2,237.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,075.30
|
| Rate for Payer: Cash Price |
$3,253.40
|
| Rate for Payer: Cigna Commercial |
$5,400.64
|
| Rate for Payer: First Health Commercial |
$6,181.45
|
| Rate for Payer: Humana Commercial |
$5,530.77
|
| Rate for Payer: Humana KY Medicaid |
$2,237.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,335.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,802.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,952.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,725.98
|
| Rate for Payer: Ohio Health Group HMO |
$4,880.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,017.10
|
| Rate for Payer: PHCS Commercial |
$6,246.52
|
| Rate for Payer: United Healthcare All Payer |
$5,725.98
|
|
|
STENT WALL 12MM*20MM
|
Facility
|
IP
|
$6,506.79
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$6,246.52 |
| Rate for Payer: Aetna Commercial |
$5,010.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,075.30
|
| Rate for Payer: Cash Price |
$3,253.40
|
| Rate for Payer: Cigna Commercial |
$5,400.64
|
| Rate for Payer: First Health Commercial |
$6,181.45
|
| Rate for Payer: Humana Commercial |
$5,530.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,335.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,802.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,952.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,725.98
|
| Rate for Payer: Ohio Health Group HMO |
$4,880.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,017.10
|
| Rate for Payer: PHCS Commercial |
$6,246.52
|
| Rate for Payer: United Healthcare All Payer |
$5,725.98
|
|
|
STENT WALL 6*24*100
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
STENT WALL 6*24*100
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
STENT WALL 6MM*24MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*24MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*36MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*36MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
