|
STENT TALNT ILIAC EXT 16*16*80
|
Facility
|
OP
|
$19,107.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,732.25 |
| Max. Negotiated Rate |
$18,343.20 |
| Rate for Payer: Aetna Commercial |
$14,712.77
|
| Rate for Payer: Anthem Medicaid |
$6,571.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,903.85
|
| Rate for Payer: Cash Price |
$9,553.75
|
| Rate for Payer: Cigna Commercial |
$15,859.23
|
| Rate for Payer: First Health Commercial |
$18,152.12
|
| Rate for Payer: Humana Commercial |
$16,241.38
|
| Rate for Payer: Humana KY Medicaid |
$6,571.07
|
| Rate for Payer: Kentucky WC Medicaid |
$6,637.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,668.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,101.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,732.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,702.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,814.60
|
| Rate for Payer: Ohio Health Group HMO |
$14,330.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,286.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,623.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,184.17
|
| Rate for Payer: PHCS Commercial |
$18,343.20
|
| Rate for Payer: United Healthcare All Payer |
$16,814.60
|
|
|
STENT TALNT ILIAC EXT 18*16*80
|
Facility
|
OP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem Medicaid |
$6,316.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Humana KY Medicaid |
$6,316.58
|
| Rate for Payer: Kentucky WC Medicaid |
$6,380.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,443.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STENT TALNT ILIAC EXT 18*16*80
|
Facility
|
IP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STENT TALNT ILIAC EXT 18*18*80
|
Facility
|
OP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem Medicaid |
$6,316.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Humana KY Medicaid |
$6,316.58
|
| Rate for Payer: Kentucky WC Medicaid |
$6,380.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,443.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STENT TALNT ILIAC EXT 18*18*80
|
Facility
|
IP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STENT TALNT ILIAC EXT 20*20*79
|
Facility
|
OP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem Medicaid |
$6,316.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Humana KY Medicaid |
$6,316.58
|
| Rate for Payer: Kentucky WC Medicaid |
$6,380.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,443.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STENT TALNT ILIAC EXT 20*20*79
|
Facility
|
IP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STENT TRACH COV ULTRA 16MM*4CM
|
Facility
|
IP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
STENT TRACH COV ULTRA 16MM*4CM
|
Facility
|
OP
|
$9,606.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.95 |
| Max. Negotiated Rate |
$9,222.24 |
| Rate for Payer: Aetna Commercial |
$7,397.01
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.07
|
| Rate for Payer: Cash Price |
$4,803.25
|
| Rate for Payer: Cigna Commercial |
$7,973.40
|
| Rate for Payer: First Health Commercial |
$9,126.17
|
| Rate for Payer: Humana Commercial |
$8,165.52
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,685.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,357.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,628.48
|
| Rate for Payer: PHCS Commercial |
$9,222.24
|
| Rate for Payer: United Healthcare All Payer |
$8,453.72
|
|
|
STENT TRACH COV ULTRA 16MM*6CM
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
STENT TRACH COV ULTRA 16MM*6CM
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
STENT TRACHEAL 18MM*4CM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT TRACHEAL 18MM*4CM
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT TRACHEAL DUMON 12*40
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT TRACHEAL DUMON 12*40
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT TRACHEAL DUMON 14*40
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT TRACHEAL DUMON 14*40
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT TRACHEAL DUMON 14*50
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT TRACHEAL DUMON 14*50
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
STENT TRACHEAL ULTRA 12MM*3CM
|
Facility
|
IP
|
$8,799.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,639.74 |
| Max. Negotiated Rate |
$8,447.16 |
| Rate for Payer: Aetna Commercial |
$6,775.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,863.31
|
| Rate for Payer: Cash Price |
$4,399.56
|
| Rate for Payer: Cigna Commercial |
$7,303.27
|
| Rate for Payer: First Health Commercial |
$8,359.16
|
| Rate for Payer: Humana Commercial |
$7,479.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,215.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,493.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,639.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,743.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,599.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,039.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,655.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,071.39
|
| Rate for Payer: PHCS Commercial |
$8,447.16
|
| Rate for Payer: United Healthcare All Payer |
$7,743.23
|
|
|
STENT TRACHEAL ULTRA 12MM*3CM
|
Facility
|
OP
|
$8,799.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,639.74 |
| Max. Negotiated Rate |
$8,447.16 |
| Rate for Payer: Aetna Commercial |
$6,775.32
|
| Rate for Payer: Anthem Medicaid |
$3,026.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,863.31
|
| Rate for Payer: Cash Price |
$4,399.56
|
| Rate for Payer: Cigna Commercial |
$7,303.27
|
| Rate for Payer: First Health Commercial |
$8,359.16
|
| Rate for Payer: Humana Commercial |
$7,479.25
|
| Rate for Payer: Humana KY Medicaid |
$3,026.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,056.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,215.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,493.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,639.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,086.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,743.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,599.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,039.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,655.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,071.39
|
| Rate for Payer: PHCS Commercial |
$8,447.16
|
| Rate for Payer: United Healthcare All Payer |
$7,743.23
|
|
|
STENT TRACHEAL ULTRA 16MM*8CM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT TRACHEAL ULTRA 16MM*8CM
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT TRACHEAL ULTRA 18MM*6CM
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
STENT TRACHEAL ULTRA 18MM*6CM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
