|
STENT ULTRAFLEX BRONCH 14*60
|
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 8*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 8*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 BRONCHIAL 10*2
|
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 ULTRAFLEX BRONCHIAL 10*2
|
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 ULTRAFLEX BRONCHIAL 10*4
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 10*4
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 12*2
|
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 ULTRAFLEX BRONCHIAL 12*2
|
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 ULTRAFLEX BRONCHIAL 12*4
|
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 ULTRAFLEX BRONCHIAL 12*4
|
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 ULTRAFLEX BRONCHIAL 14*2
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 14*2
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 14*4
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 14*4
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 14*8
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 14*8
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 16*6
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 16*6
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 BRONCHIAL 8*2
|
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 ULTRAFLEX BRONCHIAL 8*2
|
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 ULTRAFLEX BRONCHIAL 8*4
|
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 ULTRAFLEX BRONCHIAL 8*4
|
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 ULTRAFLX BRONCHIAL 14*20
|
Facility
|
OP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 ULTRAFLX BRONCHIAL 14*20
|
Facility
|
IP
|
$9,332.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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
|
|
