|
STENT VIABAHN 8MM*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 8MM*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 8MM*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 8MM*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 8MM*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 WALFLX BIL COV 10MM*80MM
|
Facility
|
IP
|
$13,901.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.60 |
| Max. Negotiated Rate |
$13,345.91 |
| Rate for Payer: Aetna Commercial |
$10,704.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,843.55
|
| Rate for Payer: Cash Price |
$6,951.00
|
| Rate for Payer: Cigna Commercial |
$11,538.65
|
| Rate for Payer: First Health Commercial |
$13,206.89
|
| Rate for Payer: Humana Commercial |
$11,816.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,399.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,259.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,170.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,233.75
|
| Rate for Payer: Ohio Health Group HMO |
$10,426.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,121.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,592.37
|
| Rate for Payer: PHCS Commercial |
$13,345.91
|
| Rate for Payer: United Healthcare All Payer |
$12,233.75
|
|
|
STENT WALFLX BIL COV 10MM*80MM
|
Facility
|
OP
|
$13,901.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.60 |
| Max. Negotiated Rate |
$13,345.91 |
| Rate for Payer: Aetna Commercial |
$10,704.53
|
| Rate for Payer: Anthem Medicaid |
$4,780.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,843.55
|
| Rate for Payer: Cash Price |
$6,951.00
|
| Rate for Payer: Cigna Commercial |
$11,538.65
|
| Rate for Payer: First Health Commercial |
$13,206.89
|
| Rate for Payer: Humana Commercial |
$11,816.69
|
| Rate for Payer: Humana KY Medicaid |
$4,780.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,829.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,399.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,259.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,170.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,876.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,233.75
|
| Rate for Payer: Ohio Health Group HMO |
$10,426.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,121.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,592.37
|
| Rate for Payer: PHCS Commercial |
$13,345.91
|
| Rate for Payer: United Healthcare All Payer |
$12,233.75
|
|
|
STENT WALFLX BIL COVERED 10*60
|
Facility
|
IP
|
$13,097.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.11 |
| Max. Negotiated Rate |
$12,573.17 |
| Rate for Payer: Aetna Commercial |
$10,084.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,215.70
|
| Rate for Payer: Cash Price |
$6,548.52
|
| Rate for Payer: Cigna Commercial |
$10,870.55
|
| Rate for Payer: First Health Commercial |
$12,442.20
|
| Rate for Payer: Humana Commercial |
$11,132.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,739.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,665.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,525.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,822.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,477.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,394.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,036.96
|
| Rate for Payer: PHCS Commercial |
$12,573.17
|
| Rate for Payer: United Healthcare All Payer |
$11,525.40
|
|
|
STENT WALFLX BIL COVERED 10*60
|
Facility
|
OP
|
$13,097.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.11 |
| Max. Negotiated Rate |
$12,573.17 |
| Rate for Payer: Aetna Commercial |
$10,084.73
|
| Rate for Payer: Anthem Medicaid |
$4,504.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,215.70
|
| Rate for Payer: Cash Price |
$6,548.52
|
| Rate for Payer: Cigna Commercial |
$10,870.55
|
| Rate for Payer: First Health Commercial |
$12,442.20
|
| Rate for Payer: Humana Commercial |
$11,132.49
|
| Rate for Payer: Humana KY Medicaid |
$4,504.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,549.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,739.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,665.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,594.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,525.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,822.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,477.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,394.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,036.96
|
| Rate for Payer: PHCS Commercial |
$12,573.17
|
| Rate for Payer: United Healthcare All Payer |
$11,525.40
|
|
|
STENT WALFLX BIL TRANSHEP 8*60
|
Facility
|
OP
|
$16,051.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,815.39 |
| Max. Negotiated Rate |
$15,409.25 |
| Rate for Payer: Aetna Commercial |
$12,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,520.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.01
|
| Rate for Payer: Cash Price |
$8,025.65
|
| Rate for Payer: Cigna Commercial |
$13,322.58
|
| Rate for Payer: First Health Commercial |
$15,248.74
|
| Rate for Payer: Humana Commercial |
$13,643.60
|
| Rate for Payer: Humana KY Medicaid |
$5,520.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,576.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,845.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,630.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.14
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,841.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,964.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,075.40
|
| Rate for Payer: PHCS Commercial |
$15,409.25
|
| Rate for Payer: United Healthcare All Payer |
$14,125.14
|
|
|
STENT WALFLX BIL TRANSHEP 8*60
|
Facility
|
IP
|
$16,051.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,815.39 |
| Max. Negotiated Rate |
$15,409.25 |
| Rate for Payer: Aetna Commercial |
$12,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,520.01
|
| Rate for Payer: Cash Price |
$8,025.65
|
| Rate for Payer: Cigna Commercial |
$13,322.58
|
| Rate for Payer: First Health Commercial |
$15,248.74
|
| Rate for Payer: Humana Commercial |
$13,643.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,162.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,845.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,815.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,125.14
|
| Rate for Payer: Ohio Health Group HMO |
$12,038.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,841.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,964.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,075.40
|
| Rate for Payer: PHCS Commercial |
$15,409.25
|
| Rate for Payer: United Healthcare All Payer |
$14,125.14
|
|
|
STENT WALL 10MM*20MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 10MM*20MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 10MM*39MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 10MM*39MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
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 WALL 12MM*20MM
|
Facility
|
OP
|
$6,706.79
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.04 |
| Max. Negotiated Rate |
$6,438.52 |
| Rate for Payer: Aetna Commercial |
$5,164.23
|
| Rate for Payer: Anthem Medicaid |
$2,306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.30
|
| Rate for Payer: Cash Price |
$3,353.40
|
| Rate for Payer: Cigna Commercial |
$5,566.64
|
| Rate for Payer: First Health Commercial |
$6,371.45
|
| Rate for Payer: Humana Commercial |
$5,700.77
|
| Rate for Payer: Humana KY Medicaid |
$2,306.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,365.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.69
|
| Rate for Payer: PHCS Commercial |
$6,438.52
|
| Rate for Payer: United Healthcare All Payer |
$5,901.98
|
|
|
STENT WALL 12MM*20MM
|
Facility
|
IP
|
$6,706.79
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.04 |
| Max. Negotiated Rate |
$6,438.52 |
| Rate for Payer: Aetna Commercial |
$5,164.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.30
|
| Rate for Payer: Cash Price |
$3,353.40
|
| Rate for Payer: Cigna Commercial |
$5,566.64
|
| Rate for Payer: First Health Commercial |
$6,371.45
|
| Rate for Payer: Humana Commercial |
$5,700.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,365.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.69
|
| Rate for Payer: PHCS Commercial |
$6,438.52
|
| Rate for Payer: United Healthcare All Payer |
$5,901.98
|
|
|
STENT WALL 6*24*100
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
STENT WALL 6*24*100
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
STENT WALL 6MM*24MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*24MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*36MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*36MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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 WALL 6MM*36MM*100CM
|
Facility
|
OP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem Medicaid |
$2,416.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Humana KY Medicaid |
$2,416.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,441.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,465.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
|
STENT WALL 6MM*36MM*100CM
|
Facility
|
IP
|
$7,027.99
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,108.40 |
| Max. Negotiated Rate |
$6,746.87 |
| Rate for Payer: Aetna Commercial |
$5,411.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,481.83
|
| Rate for Payer: Cash Price |
$3,514.00
|
| Rate for Payer: Cigna Commercial |
$5,833.23
|
| Rate for Payer: First Health Commercial |
$6,676.59
|
| Rate for Payer: Humana Commercial |
$5,973.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,762.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,186.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,184.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,270.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,622.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,114.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,849.31
|
| Rate for Payer: PHCS Commercial |
$6,746.87
|
| Rate for Payer: United Healthcare All Payer |
$6,184.63
|
|
