|
STEM WAGNER DIST PROV SZ 18
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 19
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 19
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 20
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 20
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 21
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 21
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 22
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 22
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 23
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 23
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 24
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STEM WAGNER DIST PROV SZ 24
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.00 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.30
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
STENT 15MM ON 5MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 15MM ON 5MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 15MM ON 6MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 15MM ON 6MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 5MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 5MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 6MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 18MM ON 6MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 29MM ON 7MM BALL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT 29MM ON 7MM BALL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
