|
STENT 29MM ON 8MM 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 8MM 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 39MM 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 39MM 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
|
|
|
STENT 39MM ON 8MM 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 39MM ON 8MM 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 AAA BFR 13.5CM 24MM*14MM
|
Facility
|
OP
|
$32,187.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,656.25 |
| Max. Negotiated Rate |
$30,900.00 |
| Rate for Payer: Aetna Commercial |
$24,784.38
|
| Rate for Payer: Anthem Medicaid |
$11,069.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,106.25
|
| Rate for Payer: Cash Price |
$16,093.75
|
| Rate for Payer: Cigna Commercial |
$26,715.62
|
| Rate for Payer: First Health Commercial |
$30,578.12
|
| Rate for Payer: Humana Commercial |
$27,359.38
|
| Rate for Payer: Humana KY Medicaid |
$11,069.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11,181.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,393.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,754.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,656.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,291.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,325.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,140.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,003.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,209.38
|
| Rate for Payer: PHCS Commercial |
$30,900.00
|
| Rate for Payer: United Healthcare All Payer |
$28,325.00
|
|
|
STENT AAA BFR 13.5CM 24MM*14MM
|
Facility
|
IP
|
$32,187.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,656.25 |
| Max. Negotiated Rate |
$30,900.00 |
| Rate for Payer: Aetna Commercial |
$24,784.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,106.25
|
| Rate for Payer: Cash Price |
$16,093.75
|
| Rate for Payer: Cigna Commercial |
$26,715.62
|
| Rate for Payer: First Health Commercial |
$30,578.12
|
| Rate for Payer: Humana Commercial |
$27,359.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,393.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,754.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,656.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,325.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,140.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,003.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,209.38
|
| Rate for Payer: PHCS Commercial |
$30,900.00
|
| Rate for Payer: United Healthcare All Payer |
$28,325.00
|
|
|
STENT AAA BFR 13.5CM 28MM*16MM
|
Facility
|
IP
|
$32,187.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,656.25 |
| Max. Negotiated Rate |
$30,900.00 |
| Rate for Payer: Aetna Commercial |
$24,784.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,106.25
|
| Rate for Payer: Cash Price |
$16,093.75
|
| Rate for Payer: Cigna Commercial |
$26,715.62
|
| Rate for Payer: First Health Commercial |
$30,578.12
|
| Rate for Payer: Humana Commercial |
$27,359.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,393.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,754.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,656.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,325.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,140.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,003.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,209.38
|
| Rate for Payer: PHCS Commercial |
$30,900.00
|
| Rate for Payer: United Healthcare All Payer |
$28,325.00
|
|
|
STENT AAA BFR 13.5CM 28MM*16MM
|
Facility
|
OP
|
$32,187.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,656.25 |
| Max. Negotiated Rate |
$30,900.00 |
| Rate for Payer: Aetna Commercial |
$24,784.38
|
| Rate for Payer: Anthem Medicaid |
$11,069.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,106.25
|
| Rate for Payer: Cash Price |
$16,093.75
|
| Rate for Payer: Cigna Commercial |
$26,715.62
|
| Rate for Payer: First Health Commercial |
$30,578.12
|
| Rate for Payer: Humana Commercial |
$27,359.38
|
| Rate for Payer: Humana KY Medicaid |
$11,069.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11,181.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,393.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,754.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,656.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,291.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,325.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,140.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,750.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,003.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,209.38
|
| Rate for Payer: PHCS Commercial |
$30,900.00
|
| Rate for Payer: United Healthcare All Payer |
$28,325.00
|
|
|
STENT AAA BFR 16.5CM 24MM*14MM
|
Facility
|
OP
|
$33,312.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,993.75 |
| Max. Negotiated Rate |
$31,980.00 |
| Rate for Payer: Aetna Commercial |
$25,650.62
|
| Rate for Payer: Anthem Medicaid |
$11,456.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,983.75
|
| Rate for Payer: Cash Price |
$16,656.25
|
| Rate for Payer: Cigna Commercial |
$27,649.38
|
| Rate for Payer: First Health Commercial |
$31,646.88
|
| Rate for Payer: Humana Commercial |
$28,315.62
|
| Rate for Payer: Humana KY Medicaid |
$11,456.17
|
| Rate for Payer: Kentucky WC Medicaid |
$11,572.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,316.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,584.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,315.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,981.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,985.62
|
| Rate for Payer: PHCS Commercial |
$31,980.00
|
| Rate for Payer: United Healthcare All Payer |
$29,315.00
|
|
|
STENT AAA BFR 16.5CM 24MM*14MM
|
Facility
|
IP
|
$33,312.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,993.75 |
| Max. Negotiated Rate |
$31,980.00 |
| Rate for Payer: Aetna Commercial |
$25,650.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,983.75
|
| Rate for Payer: Cash Price |
$16,656.25
|
| Rate for Payer: Cigna Commercial |
$27,649.38
|
| Rate for Payer: First Health Commercial |
$31,646.88
|
| Rate for Payer: Humana Commercial |
$28,315.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,316.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,584.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,315.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,981.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,985.62
|
| Rate for Payer: PHCS Commercial |
$31,980.00
|
| Rate for Payer: United Healthcare All Payer |
$29,315.00
|
|
|
STENT AAA BFR 16.5CM 28MM*16MM
|
Facility
|
IP
|
$33,312.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,993.75 |
| Max. Negotiated Rate |
$31,980.00 |
| Rate for Payer: Aetna Commercial |
$25,650.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,983.75
|
| Rate for Payer: Cash Price |
$16,656.25
|
| Rate for Payer: Cigna Commercial |
$27,649.38
|
| Rate for Payer: First Health Commercial |
$31,646.88
|
| Rate for Payer: Humana Commercial |
$28,315.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,316.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,584.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,315.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,981.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,985.62
|
| Rate for Payer: PHCS Commercial |
$31,980.00
|
| Rate for Payer: United Healthcare All Payer |
$29,315.00
|
|
|
STENT AAA BFR 16.5CM 28MM*16MM
|
Facility
|
OP
|
$33,312.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,993.75 |
| Max. Negotiated Rate |
$31,980.00 |
| Rate for Payer: Aetna Commercial |
$25,650.62
|
| Rate for Payer: Anthem Medicaid |
$11,456.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,983.75
|
| Rate for Payer: Cash Price |
$16,656.25
|
| Rate for Payer: Cigna Commercial |
$27,649.38
|
| Rate for Payer: First Health Commercial |
$31,646.88
|
| Rate for Payer: Humana Commercial |
$28,315.62
|
| Rate for Payer: Humana KY Medicaid |
$11,456.17
|
| Rate for Payer: Kentucky WC Medicaid |
$11,572.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,316.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,584.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,315.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,981.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,985.62
|
| Rate for Payer: PHCS Commercial |
$31,980.00
|
| Rate for Payer: United Healthcare All Payer |
$29,315.00
|
|
|
STENT AAA EXT ILIAC 12*7 GORE
|
Facility
|
IP
|
$11,790.53
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,537.16 |
| Max. Negotiated Rate |
$11,318.91 |
| Rate for Payer: Aetna Commercial |
$9,078.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,196.61
|
| Rate for Payer: Cash Price |
$5,895.26
|
| Rate for Payer: Cigna Commercial |
$9,786.14
|
| Rate for Payer: First Health Commercial |
$11,201.00
|
| Rate for Payer: Humana Commercial |
$10,021.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,668.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,701.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,537.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,375.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,842.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,432.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,257.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,135.47
|
| Rate for Payer: PHCS Commercial |
$11,318.91
|
| Rate for Payer: United Healthcare All Payer |
$10,375.67
|
|
|
STENT AAA EXT ILIAC 12*7 GORE
|
Facility
|
OP
|
$11,790.53
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,537.16 |
| Max. Negotiated Rate |
$11,318.91 |
| Rate for Payer: Aetna Commercial |
$9,078.71
|
| Rate for Payer: Anthem Medicaid |
$4,054.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,196.61
|
| Rate for Payer: Cash Price |
$5,895.26
|
| Rate for Payer: Cigna Commercial |
$9,786.14
|
| Rate for Payer: First Health Commercial |
$11,201.00
|
| Rate for Payer: Humana Commercial |
$10,021.95
|
| Rate for Payer: Humana KY Medicaid |
$4,054.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,096.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,668.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,701.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,537.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,136.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,375.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,842.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,432.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,257.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,135.47
|
| Rate for Payer: PHCS Commercial |
$11,318.91
|
| Rate for Payer: United Healthcare All Payer |
$10,375.67
|
|
|
STENT AAA EXT ILIAC 14.5*7 GOR
|
Facility
|
OP
|
$11,790.53
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,537.16 |
| Max. Negotiated Rate |
$11,318.91 |
| Rate for Payer: Aetna Commercial |
$9,078.71
|
| Rate for Payer: Anthem Medicaid |
$4,054.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,196.61
|
| Rate for Payer: Cash Price |
$5,895.26
|
| Rate for Payer: Cigna Commercial |
$9,786.14
|
| Rate for Payer: First Health Commercial |
$11,201.00
|
| Rate for Payer: Humana Commercial |
$10,021.95
|
| Rate for Payer: Humana KY Medicaid |
$4,054.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,096.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,668.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,701.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,537.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,136.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,375.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,842.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,432.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,257.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,135.47
|
| Rate for Payer: PHCS Commercial |
$11,318.91
|
| Rate for Payer: United Healthcare All Payer |
$10,375.67
|
|
|
STENT AAA EXT ILIAC 14.5*7 GOR
|
Facility
|
IP
|
$11,790.53
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,537.16 |
| Max. Negotiated Rate |
$11,318.91 |
| Rate for Payer: Aetna Commercial |
$9,078.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,196.61
|
| Rate for Payer: Cash Price |
$5,895.26
|
| Rate for Payer: Cigna Commercial |
$9,786.14
|
| Rate for Payer: First Health Commercial |
$11,201.00
|
| Rate for Payer: Humana Commercial |
$10,021.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,668.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,701.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,537.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,375.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,842.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,432.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,257.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,135.47
|
| Rate for Payer: PHCS Commercial |
$11,318.91
|
| Rate for Payer: United Healthcare All Payer |
$10,375.67
|
|
|
STENT AAA ILIAC LMB 11.5CM*14M
|
Facility
|
IP
|
$12,399.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.93 |
| Max. Negotiated Rate |
$11,903.76 |
| Rate for Payer: Aetna Commercial |
$9,547.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,671.81
|
| Rate for Payer: Cash Price |
$6,199.88
|
| Rate for Payer: Cigna Commercial |
$10,291.79
|
| Rate for Payer: First Health Commercial |
$11,779.76
|
| Rate for Payer: Humana Commercial |
$10,539.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,167.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,151.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,719.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,911.78
|
| Rate for Payer: Ohio Health Group HMO |
$9,299.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,919.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,787.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,555.83
|
| Rate for Payer: PHCS Commercial |
$11,903.76
|
| Rate for Payer: United Healthcare All Payer |
$10,911.78
|
|
|
STENT AAA ILIAC LMB 11.5CM*14M
|
Facility
|
OP
|
$12,399.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.93 |
| Max. Negotiated Rate |
$11,903.76 |
| Rate for Payer: Aetna Commercial |
$9,547.81
|
| Rate for Payer: Anthem Medicaid |
$4,264.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,671.81
|
| Rate for Payer: Cash Price |
$6,199.88
|
| Rate for Payer: Cigna Commercial |
$10,291.79
|
| Rate for Payer: First Health Commercial |
$11,779.76
|
| Rate for Payer: Humana Commercial |
$10,539.79
|
| Rate for Payer: Humana KY Medicaid |
$4,264.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,307.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,167.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,151.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,719.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,349.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,911.78
|
| Rate for Payer: Ohio Health Group HMO |
$9,299.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,919.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,787.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,555.83
|
| Rate for Payer: PHCS Commercial |
$11,903.76
|
| Rate for Payer: United Healthcare All Payer |
$10,911.78
|
|
|
STENT AAA ILIAC LMB 11.5CM*16M
|
Facility
|
IP
|
$12,399.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.93 |
| Max. Negotiated Rate |
$11,903.76 |
| Rate for Payer: Aetna Commercial |
$9,547.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,671.81
|
| Rate for Payer: Cash Price |
$6,199.88
|
| Rate for Payer: Cigna Commercial |
$10,291.79
|
| Rate for Payer: First Health Commercial |
$11,779.76
|
| Rate for Payer: Humana Commercial |
$10,539.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,167.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,151.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,719.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,911.78
|
| Rate for Payer: Ohio Health Group HMO |
$9,299.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,919.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,787.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,555.83
|
| Rate for Payer: PHCS Commercial |
$11,903.76
|
| Rate for Payer: United Healthcare All Payer |
$10,911.78
|
|
|
STENT AAA ILIAC LMB 11.5CM*16M
|
Facility
|
OP
|
$12,399.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.93 |
| Max. Negotiated Rate |
$11,903.76 |
| Rate for Payer: Aetna Commercial |
$9,547.81
|
| Rate for Payer: Anthem Medicaid |
$4,264.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,671.81
|
| Rate for Payer: Cash Price |
$6,199.88
|
| Rate for Payer: Cigna Commercial |
$10,291.79
|
| Rate for Payer: First Health Commercial |
$11,779.76
|
| Rate for Payer: Humana Commercial |
$10,539.79
|
| Rate for Payer: Humana KY Medicaid |
$4,264.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,307.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,167.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,151.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,719.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,349.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,911.78
|
| Rate for Payer: Ohio Health Group HMO |
$9,299.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,919.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,787.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,555.83
|
| Rate for Payer: PHCS Commercial |
$11,903.76
|
| Rate for Payer: United Healthcare All Payer |
$10,911.78
|
|
|
STENT AAA ILIAC LMB 8.5CM*14MM
|
Facility
|
OP
|
$11,665.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,499.72 |
| Max. Negotiated Rate |
$11,199.12 |
| Rate for Payer: Aetna Commercial |
$8,982.63
|
| Rate for Payer: Anthem Medicaid |
$4,011.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,099.28
|
| Rate for Payer: Cash Price |
$5,832.88
|
| Rate for Payer: Cigna Commercial |
$9,682.57
|
| Rate for Payer: First Health Commercial |
$11,082.46
|
| Rate for Payer: Humana Commercial |
$9,915.89
|
| Rate for Payer: Humana KY Medicaid |
$4,011.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,052.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,565.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,609.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,499.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,092.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,265.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,749.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,149.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,049.37
|
| Rate for Payer: PHCS Commercial |
$11,199.12
|
| Rate for Payer: United Healthcare All Payer |
$10,265.86
|
|
|
STENT AAA ILIAC LMB 8.5CM*14MM
|
Facility
|
IP
|
$11,665.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,499.72 |
| Max. Negotiated Rate |
$11,199.12 |
| Rate for Payer: Aetna Commercial |
$8,982.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,099.28
|
| Rate for Payer: Cash Price |
$5,832.88
|
| Rate for Payer: Cigna Commercial |
$9,682.57
|
| Rate for Payer: First Health Commercial |
$11,082.46
|
| Rate for Payer: Humana Commercial |
$9,915.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,565.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,609.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,499.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,265.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,749.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,149.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,049.37
|
| Rate for Payer: PHCS Commercial |
$11,199.12
|
| Rate for Payer: United Healthcare All Payer |
$10,265.86
|
|
|
STENT AAA ILIAC LMB 8.5CM*16MM
|
Facility
|
IP
|
$11,665.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,499.72 |
| Max. Negotiated Rate |
$11,199.12 |
| Rate for Payer: Aetna Commercial |
$8,982.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,099.28
|
| Rate for Payer: Cash Price |
$5,832.88
|
| Rate for Payer: Cigna Commercial |
$9,682.57
|
| Rate for Payer: First Health Commercial |
$11,082.46
|
| Rate for Payer: Humana Commercial |
$9,915.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,565.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,609.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,499.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,265.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,749.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,149.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,049.37
|
| Rate for Payer: PHCS Commercial |
$11,199.12
|
| Rate for Payer: United Healthcare All Payer |
$10,265.86
|
|
