|
STENT SURGITEK DBL J 6FR*24CM
|
Facility
|
IP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SURGITEK DBL J 6FR*26CM
|
Facility
|
OP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem Medicaid |
$688.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Humana KY Medicaid |
$688.39
|
| Rate for Payer: Kentucky WC Medicaid |
$695.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SURGITEK DBL J 6FR*26CM
|
Facility
|
IP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SURGITEK DBL J 6FR*28CM
|
Facility
|
IP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SURGITEK DBL J 6FR*28CM
|
Facility
|
OP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem Medicaid |
$688.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Humana KY Medicaid |
$688.39
|
| Rate for Payer: Kentucky WC Medicaid |
$695.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SURGITEK DBL J 6FR*30CM
|
Facility
|
IP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SURGITEK DBL J 6FR*30CM
|
Facility
|
OP
|
$2,001.71
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.51 |
| Max. Negotiated Rate |
$1,921.64 |
| Rate for Payer: Aetna Commercial |
$1,541.32
|
| Rate for Payer: Anthem Medicaid |
$688.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.33
|
| Rate for Payer: Cash Price |
$1,000.85
|
| Rate for Payer: Cigna Commercial |
$1,661.42
|
| Rate for Payer: First Health Commercial |
$1,901.62
|
| Rate for Payer: Humana Commercial |
$1,701.45
|
| Rate for Payer: Humana KY Medicaid |
$688.39
|
| Rate for Payer: Kentucky WC Medicaid |
$695.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.18
|
| Rate for Payer: PHCS Commercial |
$1,921.64
|
| Rate for Payer: United Healthcare All Payer |
$1,761.50
|
|
|
STENT SYMPHONY NITINOL 6*40
|
Facility
|
OP
|
$7,000.55
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.16 |
| Max. Negotiated Rate |
$6,720.53 |
| Rate for Payer: Aetna Commercial |
$5,390.42
|
| Rate for Payer: Anthem Medicaid |
$2,407.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.43
|
| Rate for Payer: Cash Price |
$3,500.27
|
| Rate for Payer: Cigna Commercial |
$5,810.46
|
| Rate for Payer: First Health Commercial |
$6,650.52
|
| Rate for Payer: Humana Commercial |
$5,950.47
|
| Rate for Payer: Humana KY Medicaid |
$2,407.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,431.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,455.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.38
|
| Rate for Payer: PHCS Commercial |
$6,720.53
|
| Rate for Payer: United Healthcare All Payer |
$6,160.48
|
|
|
STENT SYMPHONY NITINOL 6*40
|
Facility
|
IP
|
$7,000.55
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.16 |
| Max. Negotiated Rate |
$6,720.53 |
| Rate for Payer: Aetna Commercial |
$5,390.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,460.43
|
| Rate for Payer: Cash Price |
$3,500.27
|
| Rate for Payer: Cigna Commercial |
$5,810.46
|
| Rate for Payer: First Health Commercial |
$6,650.52
|
| Rate for Payer: Humana Commercial |
$5,950.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,740.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,166.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,100.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,160.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,250.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,600.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,090.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,830.38
|
| Rate for Payer: PHCS Commercial |
$6,720.53
|
| Rate for Payer: United Healthcare All Payer |
$6,160.48
|
|
|
STENT TALENT AAA BIF 24*14*140
|
Facility
|
OP
|
$36,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,978.12 |
| Max. Negotiated Rate |
$35,130.00 |
| Rate for Payer: Aetna Commercial |
$28,177.19
|
| Rate for Payer: Anthem Medicaid |
$12,584.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,543.12
|
| Rate for Payer: Cash Price |
$18,296.88
|
| Rate for Payer: Cigna Commercial |
$30,372.81
|
| Rate for Payer: First Health Commercial |
$34,764.06
|
| Rate for Payer: Humana Commercial |
$31,104.69
|
| Rate for Payer: Humana KY Medicaid |
$12,584.59
|
| Rate for Payer: Kentucky WC Medicaid |
$12,712.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,006.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,006.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,978.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,837.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,202.50
|
| Rate for Payer: Ohio Health Group HMO |
$27,445.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,836.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,249.69
|
| Rate for Payer: PHCS Commercial |
$35,130.00
|
| Rate for Payer: United Healthcare All Payer |
$32,202.50
|
|
|
STENT TALENT AAA BIF 24*14*140
|
Facility
|
IP
|
$36,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,978.12 |
| Max. Negotiated Rate |
$35,130.00 |
| Rate for Payer: Aetna Commercial |
$28,177.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,543.12
|
| Rate for Payer: Cash Price |
$18,296.88
|
| Rate for Payer: Cigna Commercial |
$30,372.81
|
| Rate for Payer: First Health Commercial |
$34,764.06
|
| Rate for Payer: Humana Commercial |
$31,104.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,006.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,006.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,978.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,202.50
|
| Rate for Payer: Ohio Health Group HMO |
$27,445.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,836.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,249.69
|
| Rate for Payer: PHCS Commercial |
$35,130.00
|
| Rate for Payer: United Healthcare All Payer |
$32,202.50
|
|
|
STENT TALENT AAA BIF 26*14*140
|
Facility
|
OP
|
$36,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,978.12 |
| Max. Negotiated Rate |
$35,130.00 |
| Rate for Payer: Aetna Commercial |
$28,177.19
|
| Rate for Payer: Anthem Medicaid |
$12,584.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,543.12
|
| Rate for Payer: Cash Price |
$18,296.88
|
| Rate for Payer: Cigna Commercial |
$30,372.81
|
| Rate for Payer: First Health Commercial |
$34,764.06
|
| Rate for Payer: Humana Commercial |
$31,104.69
|
| Rate for Payer: Humana KY Medicaid |
$12,584.59
|
| Rate for Payer: Kentucky WC Medicaid |
$12,712.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,006.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,006.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,978.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,837.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,202.50
|
| Rate for Payer: Ohio Health Group HMO |
$27,445.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,836.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,249.69
|
| Rate for Payer: PHCS Commercial |
$35,130.00
|
| Rate for Payer: United Healthcare All Payer |
$32,202.50
|
|
|
STENT TALENT AAA BIF 26*14*140
|
Facility
|
IP
|
$36,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,978.12 |
| Max. Negotiated Rate |
$35,130.00 |
| Rate for Payer: Aetna Commercial |
$28,177.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,543.12
|
| Rate for Payer: Cash Price |
$18,296.88
|
| Rate for Payer: Cigna Commercial |
$30,372.81
|
| Rate for Payer: First Health Commercial |
$34,764.06
|
| Rate for Payer: Humana Commercial |
$31,104.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,006.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,006.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,978.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,202.50
|
| Rate for Payer: Ohio Health Group HMO |
$27,445.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,836.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,249.69
|
| Rate for Payer: PHCS Commercial |
$35,130.00
|
| Rate for Payer: United Healthcare All Payer |
$32,202.50
|
|
|
STENT TALENT AAA BIF 28*14*140
|
Facility
|
IP
|
$36,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,978.12 |
| Max. Negotiated Rate |
$35,130.00 |
| Rate for Payer: Aetna Commercial |
$28,177.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,543.12
|
| Rate for Payer: Cash Price |
$18,296.88
|
| Rate for Payer: Cigna Commercial |
$30,372.81
|
| Rate for Payer: First Health Commercial |
$34,764.06
|
| Rate for Payer: Humana Commercial |
$31,104.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,006.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,006.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,978.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,202.50
|
| Rate for Payer: Ohio Health Group HMO |
$27,445.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,836.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,249.69
|
| Rate for Payer: PHCS Commercial |
$35,130.00
|
| Rate for Payer: United Healthcare All Payer |
$32,202.50
|
|
|
STENT TALENT AAA BIF 28*14*140
|
Facility
|
OP
|
$36,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,978.12 |
| Max. Negotiated Rate |
$35,130.00 |
| Rate for Payer: Aetna Commercial |
$28,177.19
|
| Rate for Payer: Anthem Medicaid |
$12,584.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,543.12
|
| Rate for Payer: Cash Price |
$18,296.88
|
| Rate for Payer: Cigna Commercial |
$30,372.81
|
| Rate for Payer: First Health Commercial |
$34,764.06
|
| Rate for Payer: Humana Commercial |
$31,104.69
|
| Rate for Payer: Humana KY Medicaid |
$12,584.59
|
| Rate for Payer: Kentucky WC Medicaid |
$12,712.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,006.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,006.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,978.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,837.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,202.50
|
| Rate for Payer: Ohio Health Group HMO |
$27,445.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,836.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,249.69
|
| Rate for Payer: PHCS Commercial |
$35,130.00
|
| Rate for Payer: United Healthcare All Payer |
$32,202.50
|
|
|
STENT TALENT AAA BIF 30*14*140
|
Facility
|
IP
|
$39,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,878.12 |
| Max. Negotiated Rate |
$38,010.00 |
| Rate for Payer: Aetna Commercial |
$30,487.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,883.12
|
| Rate for Payer: Cash Price |
$19,796.88
|
| Rate for Payer: Cigna Commercial |
$32,862.81
|
| Rate for Payer: First Health Commercial |
$37,614.06
|
| Rate for Payer: Humana Commercial |
$33,654.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,878.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,842.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,446.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,319.69
|
| Rate for Payer: PHCS Commercial |
$38,010.00
|
| Rate for Payer: United Healthcare All Payer |
$34,842.50
|
|
|
STENT TALENT AAA BIF 30*14*140
|
Facility
|
OP
|
$39,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,878.12 |
| Max. Negotiated Rate |
$38,010.00 |
| Rate for Payer: Aetna Commercial |
$30,487.19
|
| Rate for Payer: Anthem Medicaid |
$13,616.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,883.12
|
| Rate for Payer: Cash Price |
$19,796.88
|
| Rate for Payer: Cigna Commercial |
$32,862.81
|
| Rate for Payer: First Health Commercial |
$37,614.06
|
| Rate for Payer: Humana Commercial |
$33,654.69
|
| Rate for Payer: Humana KY Medicaid |
$13,616.29
|
| Rate for Payer: Kentucky WC Medicaid |
$13,754.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,878.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,889.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,842.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,446.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,319.69
|
| Rate for Payer: PHCS Commercial |
$38,010.00
|
| Rate for Payer: United Healthcare All Payer |
$34,842.50
|
|
|
STENT TALENT AAA BIF 32*14*155
|
Facility
|
OP
|
$39,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,878.12 |
| Max. Negotiated Rate |
$38,010.00 |
| Rate for Payer: Aetna Commercial |
$30,487.19
|
| Rate for Payer: Anthem Medicaid |
$13,616.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,883.12
|
| Rate for Payer: Cash Price |
$19,796.88
|
| Rate for Payer: Cigna Commercial |
$32,862.81
|
| Rate for Payer: First Health Commercial |
$37,614.06
|
| Rate for Payer: Humana Commercial |
$33,654.69
|
| Rate for Payer: Humana KY Medicaid |
$13,616.29
|
| Rate for Payer: Kentucky WC Medicaid |
$13,754.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,878.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,889.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,842.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,446.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,319.69
|
| Rate for Payer: PHCS Commercial |
$38,010.00
|
| Rate for Payer: United Healthcare All Payer |
$34,842.50
|
|
|
STENT TALENT AAA BIF 32*14*155
|
Facility
|
IP
|
$39,593.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,878.12 |
| Max. Negotiated Rate |
$38,010.00 |
| Rate for Payer: Aetna Commercial |
$30,487.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,883.12
|
| Rate for Payer: Cash Price |
$19,796.88
|
| Rate for Payer: Cigna Commercial |
$32,862.81
|
| Rate for Payer: First Health Commercial |
$37,614.06
|
| Rate for Payer: Humana Commercial |
$33,654.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,220.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,878.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,842.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,675.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,446.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,319.69
|
| Rate for Payer: PHCS Commercial |
$38,010.00
|
| Rate for Payer: United Healthcare All Payer |
$34,842.50
|
|
|
STENT TALENT AAA BIF 32*20*170
|
Facility
|
IP
|
$39,781.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,934.38 |
| Max. Negotiated Rate |
$38,190.00 |
| Rate for Payer: Aetna Commercial |
$30,631.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,029.38
|
| Rate for Payer: Cash Price |
$19,890.62
|
| Rate for Payer: Cigna Commercial |
$33,018.44
|
| Rate for Payer: First Health Commercial |
$37,792.19
|
| Rate for Payer: Humana Commercial |
$33,814.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,620.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,358.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,934.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,007.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,609.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,449.06
|
| Rate for Payer: PHCS Commercial |
$38,190.00
|
| Rate for Payer: United Healthcare All Payer |
$35,007.50
|
|
|
STENT TALENT AAA BIF 32*20*170
|
Facility
|
OP
|
$39,781.25
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,934.38 |
| Max. Negotiated Rate |
$38,190.00 |
| Rate for Payer: Aetna Commercial |
$30,631.56
|
| Rate for Payer: Anthem Medicaid |
$13,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,029.38
|
| Rate for Payer: Cash Price |
$19,890.62
|
| Rate for Payer: Cigna Commercial |
$33,018.44
|
| Rate for Payer: First Health Commercial |
$37,792.19
|
| Rate for Payer: Humana Commercial |
$33,814.06
|
| Rate for Payer: Humana KY Medicaid |
$13,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$13,820.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,620.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,358.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,934.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,955.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,007.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,609.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,449.06
|
| Rate for Payer: PHCS Commercial |
$38,190.00
|
| Rate for Payer: United Healthcare All Payer |
$35,007.50
|
|
|
STENT TALENT AAA BIF 34*16*155
|
Facility
|
IP
|
$38,843.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,653.12 |
| Max. Negotiated Rate |
$37,290.00 |
| Rate for Payer: Aetna Commercial |
$29,909.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,298.12
|
| Rate for Payer: Cash Price |
$19,421.88
|
| Rate for Payer: Cigna Commercial |
$32,240.31
|
| Rate for Payer: First Health Commercial |
$36,901.56
|
| Rate for Payer: Humana Commercial |
$33,017.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,851.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,666.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,653.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,182.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,132.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,794.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,802.19
|
| Rate for Payer: PHCS Commercial |
$37,290.00
|
| Rate for Payer: United Healthcare All Payer |
$34,182.50
|
|
|
STENT TALENT AAA BIF 34*16*155
|
Facility
|
OP
|
$38,843.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,653.12 |
| Max. Negotiated Rate |
$37,290.00 |
| Rate for Payer: Aetna Commercial |
$29,909.69
|
| Rate for Payer: Anthem Medicaid |
$13,358.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,298.12
|
| Rate for Payer: Cash Price |
$19,421.88
|
| Rate for Payer: Cigna Commercial |
$32,240.31
|
| Rate for Payer: First Health Commercial |
$36,901.56
|
| Rate for Payer: Humana Commercial |
$33,017.19
|
| Rate for Payer: Humana KY Medicaid |
$13,358.37
|
| Rate for Payer: Kentucky WC Medicaid |
$13,494.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,851.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,666.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,653.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,626.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,182.50
|
| Rate for Payer: Ohio Health Group HMO |
$29,132.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,794.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,802.19
|
| Rate for Payer: PHCS Commercial |
$37,290.00
|
| Rate for Payer: United Healthcare All Payer |
$34,182.50
|
|
|
STENT TALENT AAA BIF 34*18*170
|
Facility
|
OP
|
$40,812.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,243.75 |
| Max. Negotiated Rate |
$39,180.00 |
| Rate for Payer: Aetna Commercial |
$31,425.62
|
| Rate for Payer: Anthem Medicaid |
$14,035.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,833.75
|
| Rate for Payer: Cash Price |
$20,406.25
|
| Rate for Payer: Cigna Commercial |
$33,874.38
|
| Rate for Payer: First Health Commercial |
$38,771.88
|
| Rate for Payer: Humana Commercial |
$34,690.62
|
| Rate for Payer: Humana KY Medicaid |
$14,035.42
|
| Rate for Payer: Kentucky WC Medicaid |
$14,178.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,466.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,119.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,243.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,317.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$30,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,506.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,160.62
|
| Rate for Payer: PHCS Commercial |
$39,180.00
|
| Rate for Payer: United Healthcare All Payer |
$35,915.00
|
|
|
STENT TALENT AAA BIF 34*18*170
|
Facility
|
IP
|
$40,812.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,243.75 |
| Max. Negotiated Rate |
$39,180.00 |
| Rate for Payer: Aetna Commercial |
$31,425.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,833.75
|
| Rate for Payer: Cash Price |
$20,406.25
|
| Rate for Payer: Cigna Commercial |
$33,874.38
|
| Rate for Payer: First Health Commercial |
$38,771.88
|
| Rate for Payer: Humana Commercial |
$34,690.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,466.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,119.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,243.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$30,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,506.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,160.62
|
| Rate for Payer: PHCS Commercial |
$39,180.00
|
| Rate for Payer: United Healthcare All Payer |
$35,915.00
|
|
