|
STENT WALLGRAFT 14*50 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 14*50 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 6*50 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 6*50 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 6*70 COVERED
|
Facility
|
OP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem Medicaid |
$4,043.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Humana KY Medicaid |
$4,043.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,084.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
STENT WALLGRAFT 6*70 COVERED
|
Facility
|
IP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
STENT WALLGRAFT 8*20 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 8*20 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 8*30 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 8*30 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT ZIMMON ENDO BILI 7*10
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT ZIMMON ENDO BILI 7*10
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
STENT ZIMMON ENDO BILI 7*4
|
Facility
|
OP
|
$1,687.60
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.28 |
| Max. Negotiated Rate |
$1,620.10 |
| Rate for Payer: Aetna Commercial |
$1,299.45
|
| Rate for Payer: Anthem Medicaid |
$580.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.33
|
| Rate for Payer: Cash Price |
$843.80
|
| Rate for Payer: Cigna Commercial |
$1,400.71
|
| Rate for Payer: First Health Commercial |
$1,603.22
|
| Rate for Payer: Humana Commercial |
$1,434.46
|
| Rate for Payer: Humana KY Medicaid |
$580.37
|
| Rate for Payer: Kentucky WC Medicaid |
$586.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,383.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,265.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,350.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,468.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.44
|
| Rate for Payer: PHCS Commercial |
$1,620.10
|
| Rate for Payer: United Healthcare All Payer |
$1,485.09
|
|
|
STENT ZIMMON ENDO BILI 7*4
|
Facility
|
IP
|
$1,687.60
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.28 |
| Max. Negotiated Rate |
$1,620.10 |
| Rate for Payer: Aetna Commercial |
$1,299.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.33
|
| Rate for Payer: Cash Price |
$843.80
|
| Rate for Payer: Cigna Commercial |
$1,400.71
|
| Rate for Payer: First Health Commercial |
$1,603.22
|
| Rate for Payer: Humana Commercial |
$1,434.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,383.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,265.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,350.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,468.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.44
|
| Rate for Payer: PHCS Commercial |
$1,620.10
|
| Rate for Payer: United Healthcare All Payer |
$1,485.09
|
|
|
STENT ZIMMON ENDO BILI 7*7
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
STENT ZIMMON ENDO BILI 7*7
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
STENT ZIMMON PANCREATIC 5.0*4C
|
Facility
|
IP
|
$1,496.40
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.92 |
| Max. Negotiated Rate |
$1,436.54 |
| Rate for Payer: Aetna Commercial |
$1,152.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,167.19
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$1,242.01
|
| Rate for Payer: First Health Commercial |
$1,421.58
|
| Rate for Payer: Humana Commercial |
$1,271.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,227.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,104.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,316.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,122.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,197.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,301.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,032.52
|
| Rate for Payer: PHCS Commercial |
$1,436.54
|
| Rate for Payer: United Healthcare All Payer |
$1,316.83
|
|
|
STENT ZIMMON PANCREATIC 5.0*4C
|
Facility
|
OP
|
$1,496.40
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.92 |
| Max. Negotiated Rate |
$1,436.54 |
| Rate for Payer: Aetna Commercial |
$1,152.23
|
| Rate for Payer: Anthem Medicaid |
$514.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,167.19
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$1,242.01
|
| Rate for Payer: First Health Commercial |
$1,421.58
|
| Rate for Payer: Humana Commercial |
$1,271.94
|
| Rate for Payer: Humana KY Medicaid |
$514.61
|
| Rate for Payer: Kentucky WC Medicaid |
$519.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,227.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,104.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,316.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,122.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,197.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,301.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,032.52
|
| Rate for Payer: PHCS Commercial |
$1,436.54
|
| Rate for Payer: United Healthcare All Payer |
$1,316.83
|
|
|
STENT ZIMMON PANC W/O FLAP 3.0
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
STENT ZIMMON PANC W/O FLAP 3.0
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27000129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
STEREO RAD TREATMENT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 77432
|
| Hospital Charge Code |
33300039
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
STEREO RAD TREATMENT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 77432
|
| Hospital Charge Code |
33300039
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
STEREOTACTIC SBRT 1-5 FRACTION
|
Facility
|
IP
|
$21,178.00
|
|
|
Service Code
|
HCPCS 77373
|
| Hospital Charge Code |
33300020
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6,353.40 |
| Max. Negotiated Rate |
$20,330.88 |
| Rate for Payer: Aetna Commercial |
$16,307.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,518.84
|
| Rate for Payer: Cash Price |
$10,589.00
|
| Rate for Payer: Cigna Commercial |
$17,577.74
|
| Rate for Payer: First Health Commercial |
$20,119.10
|
| Rate for Payer: Humana Commercial |
$18,001.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,365.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,629.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,353.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,636.64
|
| Rate for Payer: Ohio Health Group HMO |
$15,883.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,942.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,424.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,612.82
|
| Rate for Payer: PHCS Commercial |
$20,330.88
|
| Rate for Payer: United Healthcare All Payer |
$18,636.64
|
|
|
STEREOTACTIC SBRT 1-5 FRACTION
|
Facility
|
OP
|
$21,178.00
|
|
|
Service Code
|
HCPCS 77373
|
| Hospital Charge Code |
33300020
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,622.43 |
| Max. Negotiated Rate |
$20,330.88 |
| Rate for Payer: Aetna Commercial |
$16,307.06
|
| Rate for Payer: Anthem Medicaid |
$7,283.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,622.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,518.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,271.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,190.28
|
| Rate for Payer: Cash Price |
$10,589.00
|
| Rate for Payer: Cash Price |
$10,589.00
|
| Rate for Payer: Cigna Commercial |
$17,577.74
|
| Rate for Payer: First Health Commercial |
$20,119.10
|
| Rate for Payer: Humana Commercial |
$18,001.30
|
| Rate for Payer: Humana KY Medicaid |
$7,283.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,622.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,357.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,365.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,629.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,946.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,636.64
|
| Rate for Payer: Ohio Health Group HMO |
$15,883.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,942.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,424.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,612.82
|
| Rate for Payer: PHCS Commercial |
$20,330.88
|
| Rate for Payer: United Healthcare All Payer |
$18,636.64
|
|
|
STERILE SCREW RIB MAXDRIVE
|
Facility
|
OP
|
$12,170.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,651.11 |
| Max. Negotiated Rate |
$11,683.56 |
| Rate for Payer: Aetna Commercial |
$9,371.19
|
| Rate for Payer: Anthem Medicaid |
$4,185.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,492.90
|
| Rate for Payer: Cash Price |
$6,085.19
|
| Rate for Payer: Cigna Commercial |
$10,101.42
|
| Rate for Payer: First Health Commercial |
$11,561.86
|
| Rate for Payer: Humana Commercial |
$10,344.82
|
| Rate for Payer: Humana KY Medicaid |
$4,185.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,227.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,979.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,981.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,651.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,269.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,709.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,127.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,736.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,588.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,397.56
|
| Rate for Payer: PHCS Commercial |
$11,683.56
|
| Rate for Payer: United Healthcare All Payer |
$10,709.93
|
|
