|
STENT ILIAC STR 15*15MM 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 15*15MM 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 15*15MM 8.5CM
|
Facility
|
OP
|
$13,317.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.18 |
| Max. Negotiated Rate |
$12,784.56 |
| Rate for Payer: Aetna Commercial |
$10,254.28
|
| Rate for Payer: Anthem Medicaid |
$4,579.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,387.45
|
| Rate for Payer: Cash Price |
$6,658.62
|
| Rate for Payer: Cigna Commercial |
$11,053.32
|
| Rate for Payer: First Health Commercial |
$12,651.39
|
| Rate for Payer: Humana Commercial |
$11,319.66
|
| Rate for Payer: Humana KY Medicaid |
$4,579.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,653.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,188.90
|
| Rate for Payer: PHCS Commercial |
$12,784.56
|
| Rate for Payer: United Healthcare All Payer |
$11,719.18
|
|
|
STENT ILIAC STR 15*15MM 8.5CM
|
Facility
|
IP
|
$13,317.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.18 |
| Max. Negotiated Rate |
$12,784.56 |
| Rate for Payer: Aetna Commercial |
$10,254.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,387.45
|
| Rate for Payer: Cash Price |
$6,658.62
|
| Rate for Payer: Cigna Commercial |
$11,053.32
|
| Rate for Payer: First Health Commercial |
$12,651.39
|
| Rate for Payer: Humana Commercial |
$11,319.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,653.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,188.90
|
| Rate for Payer: PHCS Commercial |
$12,784.56
|
| Rate for Payer: United Healthcare All Payer |
$11,719.18
|
|
|
STENT ILIAC STR 16*16MM 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 16*16MM 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 16*16MM 13.5CM
|
Facility
|
IP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
STENT ILIAC STR 16*16MM 13.5CM
|
Facility
|
OP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem Medicaid |
$6,093.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Humana KY Medicaid |
$6,093.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,155.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,216.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
STENT ILIAC STR 16*16MM 8.5CM
|
Facility
|
OP
|
$13,317.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.18 |
| Max. Negotiated Rate |
$12,784.56 |
| Rate for Payer: Aetna Commercial |
$10,254.28
|
| Rate for Payer: Anthem Medicaid |
$4,579.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,387.45
|
| Rate for Payer: Cash Price |
$6,658.62
|
| Rate for Payer: Cigna Commercial |
$11,053.32
|
| Rate for Payer: First Health Commercial |
$12,651.39
|
| Rate for Payer: Humana Commercial |
$11,319.66
|
| Rate for Payer: Humana KY Medicaid |
$4,579.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,653.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,188.90
|
| Rate for Payer: PHCS Commercial |
$12,784.56
|
| Rate for Payer: United Healthcare All Payer |
$11,719.18
|
|
|
STENT ILIAC STR 16*16MM 8.5CM
|
Facility
|
IP
|
$13,317.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.18 |
| Max. Negotiated Rate |
$12,784.56 |
| Rate for Payer: Aetna Commercial |
$10,254.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,387.45
|
| Rate for Payer: Cash Price |
$6,658.62
|
| Rate for Payer: Cigna Commercial |
$11,053.32
|
| Rate for Payer: First Health Commercial |
$12,651.39
|
| Rate for Payer: Humana Commercial |
$11,319.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,653.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,188.90
|
| Rate for Payer: PHCS Commercial |
$12,784.56
|
| Rate for Payer: United Healthcare All Payer |
$11,719.18
|
|
|
STENT ILIAC STR 18*18MM 11.5CM
|
Facility
|
IP
|
$14,234.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.43 |
| Max. Negotiated Rate |
$13,665.36 |
| Rate for Payer: Aetna Commercial |
$10,960.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.10
|
| Rate for Payer: Cash Price |
$7,117.38
|
| Rate for Payer: Cigna Commercial |
$11,814.84
|
| Rate for Payer: First Health Commercial |
$13,523.01
|
| Rate for Payer: Humana Commercial |
$12,099.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,672.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,526.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,387.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,384.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,821.98
|
| Rate for Payer: PHCS Commercial |
$13,665.36
|
| Rate for Payer: United Healthcare All Payer |
$12,526.58
|
|
|
STENT ILIAC STR 18*18MM 11.5CM
|
Facility
|
OP
|
$14,234.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.43 |
| Max. Negotiated Rate |
$13,665.36 |
| Rate for Payer: Aetna Commercial |
$10,960.76
|
| Rate for Payer: Anthem Medicaid |
$4,895.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.10
|
| Rate for Payer: Cash Price |
$7,117.38
|
| Rate for Payer: Cigna Commercial |
$11,814.84
|
| Rate for Payer: First Health Commercial |
$13,523.01
|
| Rate for Payer: Humana Commercial |
$12,099.54
|
| Rate for Payer: Humana KY Medicaid |
$4,895.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,672.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,526.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,387.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,384.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,821.98
|
| Rate for Payer: PHCS Commercial |
$13,665.36
|
| Rate for Payer: United Healthcare All Payer |
$12,526.58
|
|
|
STENT ILIAC STR 18*18MM 13.5CM
|
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 18*18MM 13.5CM
|
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 18*18MM 8.5CM
|
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 18*18MM 8.5CM
|
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 20*20MM 11.5CM
|
Facility
|
IP
|
$14,234.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.43 |
| Max. Negotiated Rate |
$13,665.36 |
| Rate for Payer: Aetna Commercial |
$10,960.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.10
|
| Rate for Payer: Cash Price |
$7,117.38
|
| Rate for Payer: Cigna Commercial |
$11,814.84
|
| Rate for Payer: First Health Commercial |
$13,523.01
|
| Rate for Payer: Humana Commercial |
$12,099.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,672.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,526.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,387.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,384.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,821.98
|
| Rate for Payer: PHCS Commercial |
$13,665.36
|
| Rate for Payer: United Healthcare All Payer |
$12,526.58
|
|
|
STENT ILIAC STR 20*20MM 11.5CM
|
Facility
|
OP
|
$14,234.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.43 |
| Max. Negotiated Rate |
$13,665.36 |
| Rate for Payer: Aetna Commercial |
$10,960.76
|
| Rate for Payer: Anthem Medicaid |
$4,895.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,103.10
|
| Rate for Payer: Cash Price |
$7,117.38
|
| Rate for Payer: Cigna Commercial |
$11,814.84
|
| Rate for Payer: First Health Commercial |
$13,523.01
|
| Rate for Payer: Humana Commercial |
$12,099.54
|
| Rate for Payer: Humana KY Medicaid |
$4,895.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,945.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,672.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,505.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,270.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,993.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,526.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,676.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,387.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,384.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,821.98
|
| Rate for Payer: PHCS Commercial |
$13,665.36
|
| Rate for Payer: United Healthcare All Payer |
$12,526.58
|
|
|
STENT ILIAC STR 20*20MM 13.5CM
|
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 20*20MM 13.5CM
|
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 20*20MM 8.5CM
|
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 20*20MM 8.5CM
|
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 LITHOSTENT 7*26
|
Facility
|
OP
|
$2,094.20
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.26 |
| Max. Negotiated Rate |
$2,010.43 |
| Rate for Payer: Aetna Commercial |
$1,612.53
|
| Rate for Payer: Anthem Medicaid |
$720.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,633.48
|
| Rate for Payer: Cash Price |
$1,047.10
|
| Rate for Payer: Cigna Commercial |
$1,738.19
|
| Rate for Payer: First Health Commercial |
$1,989.49
|
| Rate for Payer: Humana Commercial |
$1,780.07
|
| Rate for Payer: Humana KY Medicaid |
$720.20
|
| Rate for Payer: Kentucky WC Medicaid |
$727.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,717.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,545.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$734.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,842.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,445.00
|
| Rate for Payer: PHCS Commercial |
$2,010.43
|
| Rate for Payer: United Healthcare All Payer |
$1,842.90
|
|
|
STENT LITHOSTENT 7*26
|
Facility
|
IP
|
$2,094.20
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.26 |
| Max. Negotiated Rate |
$2,010.43 |
| Rate for Payer: Aetna Commercial |
$1,612.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,633.48
|
| Rate for Payer: Cash Price |
$1,047.10
|
| Rate for Payer: Cigna Commercial |
$1,738.19
|
| Rate for Payer: First Health Commercial |
$1,989.49
|
| Rate for Payer: Humana Commercial |
$1,780.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,717.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,545.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,842.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,445.00
|
| Rate for Payer: PHCS Commercial |
$2,010.43
|
| Rate for Payer: United Healthcare All Payer |
$1,842.90
|
|
|
STENT LITHOSTENT 7*28
|
Facility
|
IP
|
$2,094.20
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.26 |
| Max. Negotiated Rate |
$2,010.43 |
| Rate for Payer: Aetna Commercial |
$1,612.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,633.48
|
| Rate for Payer: Cash Price |
$1,047.10
|
| Rate for Payer: Cigna Commercial |
$1,738.19
|
| Rate for Payer: First Health Commercial |
$1,989.49
|
| Rate for Payer: Humana Commercial |
$1,780.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,717.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,545.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,842.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,445.00
|
| Rate for Payer: PHCS Commercial |
$2,010.43
|
| Rate for Payer: United Healthcare All Payer |
$1,842.90
|
|
