|
STENT ULTRAFLX PROX 10-2*16*95
|
Facility
|
IP
|
$12,634.63
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,790.39 |
| Max. Negotiated Rate |
$12,129.24 |
| Rate for Payer: Aetna Commercial |
$9,728.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,855.01
|
| Rate for Payer: Cash Price |
$6,317.31
|
| Rate for Payer: Cigna Commercial |
$10,486.74
|
| Rate for Payer: First Health Commercial |
$12,002.90
|
| Rate for Payer: Humana Commercial |
$10,739.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,360.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,324.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,790.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,118.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,475.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,107.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,992.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,717.89
|
| Rate for Payer: PHCS Commercial |
$12,129.24
|
| Rate for Payer: United Healthcare All Payer |
$11,118.47
|
|
|
STENT ULTRAFLX PROX 10-2*16*95
|
Facility
|
OP
|
$12,634.63
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,790.39 |
| Max. Negotiated Rate |
$12,129.24 |
| Rate for Payer: Aetna Commercial |
$9,728.67
|
| Rate for Payer: Anthem Medicaid |
$4,345.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,855.01
|
| Rate for Payer: Cash Price |
$6,317.31
|
| Rate for Payer: Cigna Commercial |
$10,486.74
|
| Rate for Payer: First Health Commercial |
$12,002.90
|
| Rate for Payer: Humana Commercial |
$10,739.44
|
| Rate for Payer: Humana KY Medicaid |
$4,345.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,389.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,360.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,324.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,790.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,432.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,118.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,475.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,107.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,992.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,717.89
|
| Rate for Payer: PHCS Commercial |
$12,129.24
|
| Rate for Payer: United Healthcare All Payer |
$11,118.47
|
|
|
STENT ULTRFLX BRONCH 10*30 COV
|
Facility
|
IP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 10*30 COV
|
Facility
|
OP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 12*30 COV
|
Facility
|
OP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 12*30 COV
|
Facility
|
IP
|
$10,263.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
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 ULTRFLX BRONCH 14*30 COV
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
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 ULTRFLX BRONCH 14*30 COV
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
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 ULTRFLX TRACH 14*40 PROX
|
Facility
|
OP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem Medicaid |
$3,341.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Humana KY Medicaid |
$3,341.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
|
STENT ULTRFLX TRACH 14*40 PROX
|
Facility
|
IP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
|
STENT UNI PLUS 11 FR
|
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 UNI PLUS 11 FR
|
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 VIABAHN 6MM*10CM
|
Facility
|
OP
|
$12,289.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,686.89 |
| Max. Negotiated Rate |
$11,798.06 |
| Rate for Payer: Aetna Commercial |
$9,463.03
|
| Rate for Payer: Anthem Medicaid |
$4,226.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,585.93
|
| Rate for Payer: Cash Price |
$6,144.82
|
| Rate for Payer: Cigna Commercial |
$10,200.41
|
| Rate for Payer: First Health Commercial |
$11,675.17
|
| Rate for Payer: Humana Commercial |
$10,446.20
|
| Rate for Payer: Humana KY Medicaid |
$4,226.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,269.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,077.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,069.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,814.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,217.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,831.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,692.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,479.86
|
| Rate for Payer: PHCS Commercial |
$11,798.06
|
| Rate for Payer: United Healthcare All Payer |
$10,814.89
|
|
|
STENT VIABAHN 6MM*10CM
|
Facility
|
IP
|
$12,289.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,686.89 |
| Max. Negotiated Rate |
$11,798.06 |
| Rate for Payer: Aetna Commercial |
$9,463.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,585.93
|
| Rate for Payer: Cash Price |
$6,144.82
|
| Rate for Payer: Cigna Commercial |
$10,200.41
|
| Rate for Payer: First Health Commercial |
$11,675.17
|
| Rate for Payer: Humana Commercial |
$10,446.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,077.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,069.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,814.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,217.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,831.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,692.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,479.86
|
| Rate for Payer: PHCS Commercial |
$11,798.06
|
| Rate for Payer: United Healthcare All Payer |
$10,814.89
|
|
|
STENT VIABAHN 6MM*15CM
|
Facility
|
OP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem Medicaid |
$4,731.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Humana KY Medicaid |
$4,731.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,779.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,826.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
STENT VIABAHN 6MM*15CM
|
Facility
|
IP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
STENT VIABAHN 6MM*5CM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
STENT VIABAHN 6MM*5CM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
STENT VIABAHN 7MM*10CM
|
Facility
|
OP
|
$12,289.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,686.89 |
| Max. Negotiated Rate |
$11,798.06 |
| Rate for Payer: Aetna Commercial |
$9,463.03
|
| Rate for Payer: Anthem Medicaid |
$4,226.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,585.93
|
| Rate for Payer: Cash Price |
$6,144.82
|
| Rate for Payer: Cigna Commercial |
$10,200.41
|
| Rate for Payer: First Health Commercial |
$11,675.17
|
| Rate for Payer: Humana Commercial |
$10,446.20
|
| Rate for Payer: Humana KY Medicaid |
$4,226.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,269.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,077.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,069.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,814.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,217.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,831.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,692.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,479.86
|
| Rate for Payer: PHCS Commercial |
$11,798.06
|
| Rate for Payer: United Healthcare All Payer |
$10,814.89
|
|
|
STENT VIABAHN 7MM*10CM
|
Facility
|
IP
|
$12,289.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,686.89 |
| Max. Negotiated Rate |
$11,798.06 |
| Rate for Payer: Aetna Commercial |
$9,463.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,585.93
|
| Rate for Payer: Cash Price |
$6,144.82
|
| Rate for Payer: Cigna Commercial |
$10,200.41
|
| Rate for Payer: First Health Commercial |
$11,675.17
|
| Rate for Payer: Humana Commercial |
$10,446.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,077.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,069.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,814.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,217.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,831.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,692.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,479.86
|
| Rate for Payer: PHCS Commercial |
$11,798.06
|
| Rate for Payer: United Healthcare All Payer |
$10,814.89
|
|
|
STENT VIABAHN 7MM*15CM
|
Facility
|
IP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
STENT VIABAHN 7MM*15CM
|
Facility
|
OP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem Medicaid |
$4,731.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Humana KY Medicaid |
$4,731.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,779.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,826.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
STENT VIABAHN 7MM*5MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
STENT VIABAHN 7MM*5MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
STENT VIABAHN 8MM*10CM
|
Facility
|
IP
|
$12,289.65
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,686.89 |
| Max. Negotiated Rate |
$11,798.06 |
| Rate for Payer: Aetna Commercial |
$9,463.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,585.93
|
| Rate for Payer: Cash Price |
$6,144.82
|
| Rate for Payer: Cigna Commercial |
$10,200.41
|
| Rate for Payer: First Health Commercial |
$11,675.17
|
| Rate for Payer: Humana Commercial |
$10,446.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,077.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,069.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,686.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,814.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,217.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,831.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,692.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,479.86
|
| Rate for Payer: PHCS Commercial |
$11,798.06
|
| Rate for Payer: United Healthcare All Payer |
$10,814.89
|
|
