|
STENT LITHOSTENT 7*28
|
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 NIR ROYAL 5.0MM*14MM
|
Facility
|
IP
|
$7,443.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.95 |
| Max. Negotiated Rate |
$7,145.42 |
| Rate for Payer: Aetna Commercial |
$5,731.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,805.66
|
| Rate for Payer: Cash Price |
$3,721.57
|
| Rate for Payer: Cigna Commercial |
$6,177.81
|
| Rate for Payer: First Health Commercial |
$7,070.99
|
| Rate for Payer: Humana Commercial |
$6,326.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,103.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,493.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,232.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,549.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,582.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,954.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,475.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,135.77
|
| Rate for Payer: PHCS Commercial |
$7,145.42
|
| Rate for Payer: United Healthcare All Payer |
$6,549.97
|
|
|
STENT NIR ROYAL 5.0MM*14MM
|
Facility
|
OP
|
$7,443.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.95 |
| Max. Negotiated Rate |
$7,145.42 |
| Rate for Payer: Aetna Commercial |
$5,731.23
|
| Rate for Payer: Anthem Medicaid |
$2,559.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,805.66
|
| Rate for Payer: Cash Price |
$3,721.57
|
| Rate for Payer: Cigna Commercial |
$6,177.81
|
| Rate for Payer: First Health Commercial |
$7,070.99
|
| Rate for Payer: Humana Commercial |
$6,326.68
|
| Rate for Payer: Humana KY Medicaid |
$2,559.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,585.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,103.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,493.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,232.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,611.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,549.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,582.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,954.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,475.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,135.77
|
| Rate for Payer: PHCS Commercial |
$7,145.42
|
| Rate for Payer: United Healthcare All Payer |
$6,549.97
|
|
|
STENT NIR ROYAL 5.0MM*19MM
|
Facility
|
OP
|
$7,443.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.95 |
| Max. Negotiated Rate |
$7,145.42 |
| Rate for Payer: Aetna Commercial |
$5,731.23
|
| Rate for Payer: Anthem Medicaid |
$2,559.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,805.66
|
| Rate for Payer: Cash Price |
$3,721.57
|
| Rate for Payer: Cigna Commercial |
$6,177.81
|
| Rate for Payer: First Health Commercial |
$7,070.99
|
| Rate for Payer: Humana Commercial |
$6,326.68
|
| Rate for Payer: Humana KY Medicaid |
$2,559.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,585.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,103.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,493.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,232.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,611.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,549.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,582.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,954.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,475.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,135.77
|
| Rate for Payer: PHCS Commercial |
$7,145.42
|
| Rate for Payer: United Healthcare All Payer |
$6,549.97
|
|
|
STENT NIR ROYAL 5.0MM*19MM
|
Facility
|
IP
|
$7,443.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.95 |
| Max. Negotiated Rate |
$7,145.42 |
| Rate for Payer: Aetna Commercial |
$5,731.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,805.66
|
| Rate for Payer: Cash Price |
$3,721.57
|
| Rate for Payer: Cigna Commercial |
$6,177.81
|
| Rate for Payer: First Health Commercial |
$7,070.99
|
| Rate for Payer: Humana Commercial |
$6,326.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,103.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,493.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,232.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,549.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,582.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,954.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,475.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,135.77
|
| Rate for Payer: PHCS Commercial |
$7,145.42
|
| Rate for Payer: United Healthcare All Payer |
$6,549.97
|
|
|
STENT PALMAZ GENESIS 29
|
Facility
|
OP
|
$6,777.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.33 |
| Max. Negotiated Rate |
$6,506.64 |
| Rate for Payer: Aetna Commercial |
$5,218.87
|
| Rate for Payer: Anthem Medicaid |
$2,330.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,286.65
|
| Rate for Payer: Cash Price |
$3,388.88
|
| Rate for Payer: Cigna Commercial |
$5,625.53
|
| Rate for Payer: First Health Commercial |
$6,438.86
|
| Rate for Payer: Humana Commercial |
$5,761.09
|
| Rate for Payer: Humana KY Medicaid |
$2,330.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,354.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,557.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,001.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,377.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,896.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,676.65
|
| Rate for Payer: PHCS Commercial |
$6,506.64
|
| Rate for Payer: United Healthcare All Payer |
$5,964.42
|
|
|
STENT PALMAZ GENESIS 29
|
Facility
|
IP
|
$6,777.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,033.33 |
| Max. Negotiated Rate |
$6,506.64 |
| Rate for Payer: Aetna Commercial |
$5,218.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,286.65
|
| Rate for Payer: Cash Price |
$3,388.88
|
| Rate for Payer: Cigna Commercial |
$5,625.53
|
| Rate for Payer: First Health Commercial |
$6,438.86
|
| Rate for Payer: Humana Commercial |
$5,761.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,557.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,001.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,033.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,964.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,083.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,896.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,676.65
|
| Rate for Payer: PHCS Commercial |
$6,506.64
|
| Rate for Payer: United Healthcare All Payer |
$5,964.42
|
|
|
STENT PALMAZ GENSIS 9*35 SNGLE
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
STENT PALMAZ GENSIS 9*35 SNGLE
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
STENT PERCUFLEX NEPHROURETERAL
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
STENT PERCUFLEX NEPHROURETERAL
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
STENT PLACEMT ANTE CAROTID
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
76101543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
STENT PLACEMT ANTE CAROTID
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
76101543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
STENT PLACEMT ANTE CAROTID
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
76101543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$1,520.38 |
| Rate for Payer: Ambetter Exchange |
$776.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$657.38
|
| Rate for Payer: Anthem Medicaid |
$672.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$931.60
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,520.38
|
| Rate for Payer: Humana Medicaid |
$672.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$685.77
|
| Rate for Payer: Molina Healthcare Passport |
$672.32
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.23
|
| Rate for Payer: UHCCP Medicaid |
$690.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$679.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.33
|
|
|
STENT PLACEMT ANTE CAROTID(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 37218
|
| Hospital Charge Code |
761P1543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$1,520.38 |
| Rate for Payer: Ambetter Exchange |
$776.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$657.38
|
| Rate for Payer: Anthem Medicaid |
$672.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$931.60
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,520.38
|
| Rate for Payer: Humana Medicaid |
$672.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$685.77
|
| Rate for Payer: Molina Healthcare Passport |
$672.32
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.23
|
| Rate for Payer: UHCCP Medicaid |
$690.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$679.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.33
|
|
|
STENT PLACEMT RETRO CAROTID
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
76101542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
STENT PLACEMT RETRO CAROTID
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
76101542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$2,054.10 |
| Rate for Payer: Ambetter Exchange |
$1,015.24
|
| Rate for Payer: Anthem Medicaid |
$906.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,015.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,015.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,218.29
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$2,054.10
|
| Rate for Payer: Healthspan PPO |
$1,484.35
|
| Rate for Payer: Humana Medicaid |
$906.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,015.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$924.30
|
| Rate for Payer: Molina Healthcare Passport |
$906.18
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,319.81
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$915.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,015.24
|
|
|
STENT PLACEMT RETRO CAROTID
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
76101542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
STENT PLACEMT RETRO CAROTID(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 37217
|
| Hospital Charge Code |
761P1542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$2,054.10 |
| Rate for Payer: Ambetter Exchange |
$1,015.24
|
| Rate for Payer: Anthem Medicaid |
$906.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,015.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,015.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,218.29
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$2,054.10
|
| Rate for Payer: Healthspan PPO |
$1,484.35
|
| Rate for Payer: Humana Medicaid |
$906.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,015.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$924.30
|
| Rate for Payer: Molina Healthcare Passport |
$906.18
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,319.81
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$915.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,015.24
|
|
|
STENT PLMT CTR DIALYSIS SEG
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
76101521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
STENT PLMT CTR DIALYSIS SEG
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
76101521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$2,023.28 |
| Rate for Payer: Ambetter Exchange |
$193.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.45
|
| Rate for Payer: Anthem Medicaid |
$1,983.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$193.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$193.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.69
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$312.96
|
| Rate for Payer: Humana Medicaid |
$1,983.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$193.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,023.28
|
| Rate for Payer: Molina Healthcare Passport |
$1,983.61
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.08
|
| Rate for Payer: UHCCP Medicaid |
$168.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,003.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.91
|
|
|
STENT PLMT CTR DIALYSIS SEG
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
76101521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
STENT PLMT CTR DIALYSIS SEG(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 36908
|
| Hospital Charge Code |
761P1521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$2,023.28 |
| Rate for Payer: Ambetter Exchange |
$193.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$160.45
|
| Rate for Payer: Anthem Medicaid |
$1,983.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$193.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$193.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.69
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$312.96
|
| Rate for Payer: Humana Medicaid |
$1,983.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$193.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,023.28
|
| Rate for Payer: Molina Healthcare Passport |
$1,983.61
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.08
|
| Rate for Payer: UHCCP Medicaid |
$168.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,003.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.91
|
|
|
STENT PLYFLX ESOPH 23/18M*120M
|
Facility
|
OP
|
$11,438.21
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.46 |
| Max. Negotiated Rate |
$10,980.68 |
| Rate for Payer: Aetna Commercial |
$8,807.42
|
| Rate for Payer: Anthem Medicaid |
$3,933.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,921.80
|
| Rate for Payer: Cash Price |
$5,719.10
|
| Rate for Payer: Cigna Commercial |
$9,493.71
|
| Rate for Payer: First Health Commercial |
$10,866.30
|
| Rate for Payer: Humana Commercial |
$9,722.48
|
| Rate for Payer: Humana KY Medicaid |
$3,933.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,973.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,379.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,441.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,431.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,012.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,065.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,578.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,150.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,951.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,892.36
|
| Rate for Payer: PHCS Commercial |
$10,980.68
|
| Rate for Payer: United Healthcare All Payer |
$10,065.62
|
|
|
STENT PLYFLX ESOPH 23/18M*120M
|
Facility
|
IP
|
$11,438.21
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.46 |
| Max. Negotiated Rate |
$10,980.68 |
| Rate for Payer: Aetna Commercial |
$8,807.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,921.80
|
| Rate for Payer: Cash Price |
$5,719.10
|
| Rate for Payer: Cigna Commercial |
$9,493.71
|
| Rate for Payer: First Health Commercial |
$10,866.30
|
| Rate for Payer: Humana Commercial |
$9,722.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,379.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,441.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,431.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,065.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,578.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,150.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,951.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,892.36
|
| Rate for Payer: PHCS Commercial |
$10,980.68
|
| Rate for Payer: United Healthcare All Payer |
$10,065.62
|
|
