|
STENT ILIAC FLR 18*22MM 13.5CM
|
Facility
|
OP
|
$17,905.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,371.50 |
| Max. Negotiated Rate |
$17,188.80 |
| Rate for Payer: Aetna Commercial |
$13,786.85
|
| Rate for Payer: Anthem Medicaid |
$6,157.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,965.90
|
| Rate for Payer: Cash Price |
$8,952.50
|
| Rate for Payer: Cigna Commercial |
$14,861.15
|
| Rate for Payer: First Health Commercial |
$17,009.75
|
| Rate for Payer: Humana Commercial |
$15,219.25
|
| Rate for Payer: Humana KY Medicaid |
$6,157.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,220.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,682.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,213.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,371.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,281.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,756.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,577.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,354.45
|
| Rate for Payer: PHCS Commercial |
$17,188.80
|
| Rate for Payer: United Healthcare All Payer |
$15,756.40
|
|
|
STENT ILIAC FLR 18*24MM 11.5CM
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
STENT ILIAC FLR 18*24MM 11.5CM
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
STENT ILIAC FLR 18*24MM 13.5CM
|
Facility
|
IP
|
$17,905.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,371.50 |
| Max. Negotiated Rate |
$17,188.80 |
| Rate for Payer: Aetna Commercial |
$13,786.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,965.90
|
| Rate for Payer: Cash Price |
$8,952.50
|
| Rate for Payer: Cigna Commercial |
$14,861.15
|
| Rate for Payer: First Health Commercial |
$17,009.75
|
| Rate for Payer: Humana Commercial |
$15,219.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,682.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,213.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,371.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,756.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,577.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,354.45
|
| Rate for Payer: PHCS Commercial |
$17,188.80
|
| Rate for Payer: United Healthcare All Payer |
$15,756.40
|
|
|
STENT ILIAC FLR 18*24MM 13.5CM
|
Facility
|
OP
|
$17,905.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,371.50 |
| Max. Negotiated Rate |
$17,188.80 |
| Rate for Payer: Aetna Commercial |
$13,786.85
|
| Rate for Payer: Anthem Medicaid |
$6,157.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,965.90
|
| Rate for Payer: Cash Price |
$8,952.50
|
| Rate for Payer: Cigna Commercial |
$14,861.15
|
| Rate for Payer: First Health Commercial |
$17,009.75
|
| Rate for Payer: Humana Commercial |
$15,219.25
|
| Rate for Payer: Humana KY Medicaid |
$6,157.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,220.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,682.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,213.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,371.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,281.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,756.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,577.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,354.45
|
| Rate for Payer: PHCS Commercial |
$17,188.80
|
| Rate for Payer: United Healthcare All Payer |
$15,756.40
|
|
|
STENT ILIAC STR 12*12MM 11.5CM
|
Facility
|
IP
|
$15,685.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.50 |
| Max. Negotiated Rate |
$15,057.60 |
| Rate for Payer: Aetna Commercial |
$12,077.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,234.30
|
| Rate for Payer: Cash Price |
$7,842.50
|
| Rate for Payer: Cigna Commercial |
$13,018.55
|
| Rate for Payer: First Health Commercial |
$14,900.75
|
| Rate for Payer: Humana Commercial |
$13,332.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,861.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,575.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,802.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,763.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,822.65
|
| Rate for Payer: PHCS Commercial |
$15,057.60
|
| Rate for Payer: United Healthcare All Payer |
$13,802.80
|
|
|
STENT ILIAC STR 12*12MM 11.5CM
|
Facility
|
OP
|
$15,685.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.50 |
| Max. Negotiated Rate |
$15,057.60 |
| Rate for Payer: Aetna Commercial |
$12,077.45
|
| Rate for Payer: Anthem Medicaid |
$5,394.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,234.30
|
| Rate for Payer: Cash Price |
$7,842.50
|
| Rate for Payer: Cigna Commercial |
$13,018.55
|
| Rate for Payer: First Health Commercial |
$14,900.75
|
| Rate for Payer: Humana Commercial |
$13,332.25
|
| Rate for Payer: Humana KY Medicaid |
$5,394.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,448.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,861.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,575.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,705.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,502.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,802.80
|
| Rate for Payer: Ohio Health Group HMO |
$11,763.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,548.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,822.65
|
| Rate for Payer: PHCS Commercial |
$15,057.60
|
| Rate for Payer: United Healthcare All Payer |
$13,802.80
|
|
|
STENT ILIAC STR 12*12MM 13.5CM
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
STENT ILIAC STR 12*12MM 13.5CM
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
STENT ILIAC STR 12*12MM 8.5CM
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
STENT ILIAC STR 12*12MM 8.5CM
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
STENT ILIAC STR 13*13MM 11.5CM
|
Facility
|
OP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.27 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem Medicaid |
$4,706.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Humana KY Medicaid |
$4,706.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,753.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,800.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,905.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,442.13
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
STENT ILIAC STR 13*13MM 11.5CM
|
Facility
|
IP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.27 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,905.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,442.13
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
STENT ILIAC STR 13*13MM 13.5CM
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
STENT ILIAC STR 13*13MM 13.5CM
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
STENT ILIAC STR 13*13MM 8.5CM
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
STENT ILIAC STR 13*13MM 8.5CM
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
STENT ILIAC STR 14*14MM 11.5CM
|
Facility
|
IP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.27 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,905.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,442.13
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
STENT ILIAC STR 14*14MM 11.5CM
|
Facility
|
OP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.27 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem Medicaid |
$4,706.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Humana KY Medicaid |
$4,706.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,753.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,800.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,905.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,442.13
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
STENT ILIAC STR 14*14MM 13.5CM
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
STENT ILIAC STR 14*14MM 13.5CM
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
STENT ILIAC STR 14*14MM 8.5CM
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
STENT ILIAC STR 14*14MM 8.5CM
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
STENT ILIAC STR 15*15MM 11.5CM
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
STENT ILIAC STR 15*15MM 11.5CM
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
