|
STENT TRACHEAL ULTRA 18MM*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 18MM*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 20MM*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 ULTRA 20MM*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 ULTRA 20MM*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 20MM*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
|
|
|
STENT TRACHEAL ULTRA 20MM*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 20MM*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 TRACH ULTRA COV 14MM*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 ULTRA COV 14MM*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 ULTRA COV 14MM*6CM
|
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 ULTRA COV 14MM*6CM
|
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 TRIA FIRM 8F*28CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT TRIA FIRM 8F*28CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT TRIA SOFT 7F*26CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT TRIA SOFT 7F*26CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STENT ULTRAFLEX BRONCH 10*20
|
Facility
|
IP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
|
STENT ULTRAFLEX BRONCH 10*20
|
Facility
|
OP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem Medicaid |
$3,529.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Humana KY Medicaid |
$3,529.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,565.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,600.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
|
STENT ULTRAFLEX BRONCH 10*30
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,799.82 |
| Max. Negotiated Rate |
$8,959.44 |
| Rate for Payer: Aetna Commercial |
$7,186.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,279.55
|
| Rate for Payer: Cash Price |
$4,666.38
|
| Rate for Payer: Cigna Commercial |
$7,746.18
|
| Rate for Payer: First Health Commercial |
$8,866.11
|
| Rate for Payer: Humana Commercial |
$7,932.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,652.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,887.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,799.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,212.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,999.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,119.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,439.60
|
| Rate for Payer: PHCS Commercial |
$8,959.44
|
| Rate for Payer: United Healthcare All Payer |
$8,212.82
|
|
|
STENT ULTRAFLEX BRONCH 10*30
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,799.82 |
| Max. Negotiated Rate |
$8,959.44 |
| Rate for Payer: Aetna Commercial |
$7,186.22
|
| Rate for Payer: Anthem Medicaid |
$3,209.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,279.55
|
| Rate for Payer: Cash Price |
$4,666.38
|
| Rate for Payer: Cigna Commercial |
$7,746.18
|
| Rate for Payer: First Health Commercial |
$8,866.11
|
| Rate for Payer: Humana Commercial |
$7,932.84
|
| Rate for Payer: Humana KY Medicaid |
$3,209.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,652.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,887.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,799.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,273.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,212.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,999.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,119.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,439.60
|
| Rate for Payer: PHCS Commercial |
$8,959.44
|
| Rate for Payer: United Healthcare All Payer |
$8,212.82
|
|
|
STENT ULTRAFLEX BRONCH 12*20
|
Facility
|
OP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem Medicaid |
$3,529.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Humana KY Medicaid |
$3,529.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,565.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,600.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
|
STENT ULTRAFLEX BRONCH 12*20
|
Facility
|
IP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
|
STENT ULTRAFLEX BRONCH 12*40
|
Facility
|
IP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
|
STENT ULTRAFLEX BRONCH 12*40
|
Facility
|
OP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem Medicaid |
$3,529.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Humana KY Medicaid |
$3,529.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,565.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,600.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
|
STENT ULTRAFLEX BRONCH 14*60
|
Facility
|
IP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.05 |
| Max. Negotiated Rate |
$9,852.96 |
| Rate for Payer: Aetna Commercial |
$7,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,005.53
|
| Rate for Payer: Cash Price |
$5,131.75
|
| Rate for Payer: Cigna Commercial |
$8,518.70
|
| Rate for Payer: First Health Commercial |
$9,750.33
|
| Rate for Payer: Humana Commercial |
$8,723.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,574.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,031.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,697.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,210.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,929.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,081.81
|
| Rate for Payer: PHCS Commercial |
$9,852.96
|
| Rate for Payer: United Healthcare All Payer |
$9,031.88
|
|
