|
STENT BIFUR 13.5CM 20M*12M
|
Facility
|
OP
|
$34,156.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,246.88 |
| Max. Negotiated Rate |
$32,790.00 |
| Rate for Payer: Aetna Commercial |
$26,300.31
|
| Rate for Payer: Anthem Medicaid |
$11,746.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,641.88
|
| Rate for Payer: Cash Price |
$17,078.12
|
| Rate for Payer: Cigna Commercial |
$28,349.69
|
| Rate for Payer: First Health Commercial |
$32,448.44
|
| Rate for Payer: Humana Commercial |
$29,032.81
|
| Rate for Payer: Humana KY Medicaid |
$11,746.33
|
| Rate for Payer: Kentucky WC Medicaid |
$11,865.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,008.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,207.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,246.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,982.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,057.50
|
| Rate for Payer: Ohio Health Group HMO |
$25,617.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,715.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,567.81
|
| Rate for Payer: PHCS Commercial |
$32,790.00
|
| Rate for Payer: United Healthcare All Payer |
$30,057.50
|
|
|
STENT BIFUR 13.5CM 22M*13M
|
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 BIFUR 13.5CM 22M*13M
|
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 BIFUR 13.5CM 24M*14M
|
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 BIFUR 13.5CM 24M*14M
|
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 BIFUR 13.5CM 26M*15M
|
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 BIFUR 13.5CM 26M*15M
|
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 BIFUR 13.5CM 28M*16M
|
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 BIFUR 13.5CM 28M*16M
|
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 BIFUR 16.5CM 20M*12M
|
Facility
|
IP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,275.00 |
| Max. Negotiated Rate |
$32,880.00 |
| Rate for Payer: Aetna Commercial |
$26,372.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,715.00
|
| Rate for Payer: Cash Price |
$17,125.00
|
| Rate for Payer: Cigna Commercial |
$28,427.50
|
| Rate for Payer: First Health Commercial |
$32,537.50
|
| Rate for Payer: Humana Commercial |
$29,112.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,085.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,276.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,140.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,797.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,632.50
|
| Rate for Payer: PHCS Commercial |
$32,880.00
|
| Rate for Payer: United Healthcare All Payer |
$30,140.00
|
|
|
STENT BIFUR 16.5CM 20M*12M
|
Facility
|
OP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,275.00 |
| Max. Negotiated Rate |
$32,880.00 |
| Rate for Payer: Aetna Commercial |
$26,372.50
|
| Rate for Payer: Anthem Medicaid |
$11,778.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,715.00
|
| Rate for Payer: Cash Price |
$17,125.00
|
| Rate for Payer: Cigna Commercial |
$28,427.50
|
| Rate for Payer: First Health Commercial |
$32,537.50
|
| Rate for Payer: Humana Commercial |
$29,112.50
|
| Rate for Payer: Humana KY Medicaid |
$11,778.58
|
| Rate for Payer: Kentucky WC Medicaid |
$11,898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,085.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,276.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,014.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,140.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,797.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,632.50
|
| Rate for Payer: PHCS Commercial |
$32,880.00
|
| Rate for Payer: United Healthcare All Payer |
$30,140.00
|
|
|
STENT BIFUR 16.5CM 22M*13M
|
Facility
|
OP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,275.00 |
| Max. Negotiated Rate |
$32,880.00 |
| Rate for Payer: Aetna Commercial |
$26,372.50
|
| Rate for Payer: Anthem Medicaid |
$11,778.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,715.00
|
| Rate for Payer: Cash Price |
$17,125.00
|
| Rate for Payer: Cigna Commercial |
$28,427.50
|
| Rate for Payer: First Health Commercial |
$32,537.50
|
| Rate for Payer: Humana Commercial |
$29,112.50
|
| Rate for Payer: Humana KY Medicaid |
$11,778.58
|
| Rate for Payer: Kentucky WC Medicaid |
$11,898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,085.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,276.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,014.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,140.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,797.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,632.50
|
| Rate for Payer: PHCS Commercial |
$32,880.00
|
| Rate for Payer: United Healthcare All Payer |
$30,140.00
|
|
|
STENT BIFUR 16.5CM 22M*13M
|
Facility
|
IP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,275.00 |
| Max. Negotiated Rate |
$32,880.00 |
| Rate for Payer: Aetna Commercial |
$26,372.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,715.00
|
| Rate for Payer: Cash Price |
$17,125.00
|
| Rate for Payer: Cigna Commercial |
$28,427.50
|
| Rate for Payer: First Health Commercial |
$32,537.50
|
| Rate for Payer: Humana Commercial |
$29,112.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,085.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,276.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,140.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,797.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,632.50
|
| Rate for Payer: PHCS Commercial |
$32,880.00
|
| Rate for Payer: United Healthcare All Payer |
$30,140.00
|
|
|
STENT BIFUR 16.5CM 24M*14M
|
Facility
|
IP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,275.00 |
| Max. Negotiated Rate |
$32,880.00 |
| Rate for Payer: Aetna Commercial |
$26,372.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,715.00
|
| Rate for Payer: Cash Price |
$17,125.00
|
| Rate for Payer: Cigna Commercial |
$28,427.50
|
| Rate for Payer: First Health Commercial |
$32,537.50
|
| Rate for Payer: Humana Commercial |
$29,112.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,085.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,276.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,140.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,797.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,632.50
|
| Rate for Payer: PHCS Commercial |
$32,880.00
|
| Rate for Payer: United Healthcare All Payer |
$30,140.00
|
|
|
STENT BIFUR 16.5CM 24M*14M
|
Facility
|
OP
|
$34,250.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,275.00 |
| Max. Negotiated Rate |
$32,880.00 |
| Rate for Payer: Aetna Commercial |
$26,372.50
|
| Rate for Payer: Anthem Medicaid |
$11,778.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,715.00
|
| Rate for Payer: Cash Price |
$17,125.00
|
| Rate for Payer: Cigna Commercial |
$28,427.50
|
| Rate for Payer: First Health Commercial |
$32,537.50
|
| Rate for Payer: Humana Commercial |
$29,112.50
|
| Rate for Payer: Humana KY Medicaid |
$11,778.58
|
| Rate for Payer: Kentucky WC Medicaid |
$11,898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,085.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,276.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,014.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,140.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,797.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,632.50
|
| Rate for Payer: PHCS Commercial |
$32,880.00
|
| Rate for Payer: United Healthcare All Payer |
$30,140.00
|
|
|
STENT BIFUR 16.5CM 26M*15M
|
Facility
|
OP
|
$36,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,837.50 |
| Max. Negotiated Rate |
$34,680.00 |
| Rate for Payer: Aetna Commercial |
$27,816.25
|
| Rate for Payer: Anthem Medicaid |
$12,423.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,177.50
|
| Rate for Payer: Cash Price |
$18,062.50
|
| Rate for Payer: Cigna Commercial |
$29,983.75
|
| Rate for Payer: First Health Commercial |
$34,318.75
|
| Rate for Payer: Humana Commercial |
$30,706.25
|
| Rate for Payer: Humana KY Medicaid |
$12,423.39
|
| Rate for Payer: Kentucky WC Medicaid |
$12,549.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,622.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,660.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,837.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,672.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,790.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,428.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,926.25
|
| Rate for Payer: PHCS Commercial |
$34,680.00
|
| Rate for Payer: United Healthcare All Payer |
$31,790.00
|
|
|
STENT BIFUR 16.5CM 26M*15M
|
Facility
|
IP
|
$36,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,837.50 |
| Max. Negotiated Rate |
$34,680.00 |
| Rate for Payer: Aetna Commercial |
$27,816.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,177.50
|
| Rate for Payer: Cash Price |
$18,062.50
|
| Rate for Payer: Cigna Commercial |
$29,983.75
|
| Rate for Payer: First Health Commercial |
$34,318.75
|
| Rate for Payer: Humana Commercial |
$30,706.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,622.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,660.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,837.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,790.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,428.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,926.25
|
| Rate for Payer: PHCS Commercial |
$34,680.00
|
| Rate for Payer: United Healthcare All Payer |
$31,790.00
|
|
|
STENT BIFUR 16.5CM 28M*16M
|
Facility
|
IP
|
$34,906.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,471.88 |
| Max. Negotiated Rate |
$33,510.00 |
| Rate for Payer: Aetna Commercial |
$26,877.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,226.88
|
| Rate for Payer: Cash Price |
$17,453.12
|
| Rate for Payer: Cigna Commercial |
$28,972.19
|
| Rate for Payer: First Health Commercial |
$33,160.94
|
| Rate for Payer: Humana Commercial |
$29,670.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,623.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,760.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,717.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,368.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,085.31
|
| Rate for Payer: PHCS Commercial |
$33,510.00
|
| Rate for Payer: United Healthcare All Payer |
$30,717.50
|
|
|
STENT BIFUR 16.5CM 28M*16M
|
Facility
|
OP
|
$34,906.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,471.88 |
| Max. Negotiated Rate |
$33,510.00 |
| Rate for Payer: Aetna Commercial |
$26,877.81
|
| Rate for Payer: Anthem Medicaid |
$12,004.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,226.88
|
| Rate for Payer: Cash Price |
$17,453.12
|
| Rate for Payer: Cigna Commercial |
$28,972.19
|
| Rate for Payer: First Health Commercial |
$33,160.94
|
| Rate for Payer: Humana Commercial |
$29,670.31
|
| Rate for Payer: Humana KY Medicaid |
$12,004.26
|
| Rate for Payer: Kentucky WC Medicaid |
$12,126.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,623.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,760.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,245.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,717.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,368.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,085.31
|
| Rate for Payer: PHCS Commercial |
$33,510.00
|
| Rate for Payer: United Healthcare All Payer |
$30,717.50
|
|
|
STENT BILIARY 7*10 RAP EX
|
Facility
|
IP
|
$1,576.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$1,513.15 |
| Rate for Payer: Aetna Commercial |
$1,213.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.44
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$1,308.25
|
| Rate for Payer: First Health Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial |
$1,339.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.58
|
| Rate for Payer: PHCS Commercial |
$1,513.15
|
| Rate for Payer: United Healthcare All Payer |
$1,387.06
|
|
|
STENT BILIARY 7*10 RAP EX
|
Facility
|
OP
|
$1,576.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$1,513.15 |
| Rate for Payer: Aetna Commercial |
$1,213.67
|
| Rate for Payer: Anthem Medicaid |
$542.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.44
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$1,308.25
|
| Rate for Payer: First Health Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial |
$1,339.77
|
| Rate for Payer: Humana KY Medicaid |
$542.06
|
| Rate for Payer: Kentucky WC Medicaid |
$547.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.58
|
| Rate for Payer: PHCS Commercial |
$1,513.15
|
| Rate for Payer: United Healthcare All Payer |
$1,387.06
|
|
|
STENT BILIARY 7*12 RAP EXC
|
Facility
|
IP
|
$1,576.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$1,513.15 |
| Rate for Payer: Aetna Commercial |
$1,213.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.44
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$1,308.25
|
| Rate for Payer: First Health Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial |
$1,339.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.58
|
| Rate for Payer: PHCS Commercial |
$1,513.15
|
| Rate for Payer: United Healthcare All Payer |
$1,387.06
|
|
|
STENT BILIARY 7*12 RAP EXC
|
Facility
|
OP
|
$1,576.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$1,513.15 |
| Rate for Payer: Aetna Commercial |
$1,213.67
|
| Rate for Payer: Anthem Medicaid |
$542.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.44
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$1,308.25
|
| Rate for Payer: First Health Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial |
$1,339.77
|
| Rate for Payer: Humana KY Medicaid |
$542.06
|
| Rate for Payer: Kentucky WC Medicaid |
$547.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.58
|
| Rate for Payer: PHCS Commercial |
$1,513.15
|
| Rate for Payer: United Healthcare All Payer |
$1,387.06
|
|
|
STENT BILIARY 7*15 RAP EXC
|
Facility
|
IP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
|
STENT BILIARY 7*15 RAP EXC
|
Facility
|
OP
|
$1,729.40
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.82 |
| Max. Negotiated Rate |
$1,660.22 |
| Rate for Payer: Aetna Commercial |
$1,331.64
|
| Rate for Payer: Anthem Medicaid |
$594.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.93
|
| Rate for Payer: Cash Price |
$864.70
|
| Rate for Payer: Cigna Commercial |
$1,435.40
|
| Rate for Payer: First Health Commercial |
$1,642.93
|
| Rate for Payer: Humana Commercial |
$1,469.99
|
| Rate for Payer: Humana KY Medicaid |
$594.74
|
| Rate for Payer: Kentucky WC Medicaid |
$600.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.29
|
| Rate for Payer: PHCS Commercial |
$1,660.22
|
| Rate for Payer: United Healthcare All Payer |
$1,521.87
|
|
