|
STENT DYNAMIC Y 15*12
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
STENT DYNAMIC Y 15*12
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
STENT ESOPH 7CM COVERED
|
Facility
|
IP
|
$8,366.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.61 |
| Max. Negotiated Rate |
$8,031.60 |
| Rate for Payer: Aetna Commercial |
$6,442.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.68
|
| Rate for Payer: Cash Price |
$4,183.12
|
| Rate for Payer: Cigna Commercial |
$6,943.99
|
| Rate for Payer: First Health Commercial |
$7,947.94
|
| Rate for Payer: Humana Commercial |
$7,111.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,860.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,362.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,593.54
|
| Rate for Payer: PHCS Commercial |
$8,031.60
|
| Rate for Payer: United Healthcare All Payer |
$7,362.30
|
|
|
STENT ESOPH 7CM COVERED
|
Facility
|
OP
|
$8,366.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.61 |
| Max. Negotiated Rate |
$8,031.60 |
| Rate for Payer: Aetna Commercial |
$6,442.01
|
| Rate for Payer: Anthem Medicaid |
$2,877.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.68
|
| Rate for Payer: Cash Price |
$4,183.12
|
| Rate for Payer: Cigna Commercial |
$6,943.99
|
| Rate for Payer: First Health Commercial |
$7,947.94
|
| Rate for Payer: Humana Commercial |
$7,111.31
|
| Rate for Payer: Humana KY Medicaid |
$2,877.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,860.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,362.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,593.54
|
| Rate for Payer: PHCS Commercial |
$8,031.60
|
| Rate for Payer: United Healthcare All Payer |
$7,362.30
|
|
|
STENT ESOPH 9CM COVERED
|
Facility
|
IP
|
$8,366.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.61 |
| Max. Negotiated Rate |
$8,031.60 |
| Rate for Payer: Aetna Commercial |
$6,442.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.68
|
| Rate for Payer: Cash Price |
$4,183.12
|
| Rate for Payer: Cigna Commercial |
$6,943.99
|
| Rate for Payer: First Health Commercial |
$7,947.94
|
| Rate for Payer: Humana Commercial |
$7,111.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,860.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,362.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,593.54
|
| Rate for Payer: PHCS Commercial |
$8,031.60
|
| Rate for Payer: United Healthcare All Payer |
$7,362.30
|
|
|
STENT ESOPH 9CM COVERED
|
Facility
|
OP
|
$8,366.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.61 |
| Max. Negotiated Rate |
$8,031.60 |
| Rate for Payer: Aetna Commercial |
$6,442.01
|
| Rate for Payer: Anthem Medicaid |
$2,877.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.68
|
| Rate for Payer: Cash Price |
$4,183.12
|
| Rate for Payer: Cigna Commercial |
$6,943.99
|
| Rate for Payer: First Health Commercial |
$7,947.94
|
| Rate for Payer: Humana Commercial |
$7,111.31
|
| Rate for Payer: Humana KY Medicaid |
$2,877.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,860.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,362.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,593.54
|
| Rate for Payer: PHCS Commercial |
$8,031.60
|
| Rate for Payer: United Healthcare All Payer |
$7,362.30
|
|
|
STENT ESOPH LRG 23*7CM COVERED
|
Facility
|
OP
|
$8,530.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.96 |
| Max. Negotiated Rate |
$8,189.28 |
| Rate for Payer: Aetna Commercial |
$6,568.48
|
| Rate for Payer: Anthem Medicaid |
$2,933.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.79
|
| Rate for Payer: Cash Price |
$4,265.25
|
| Rate for Payer: Cigna Commercial |
$7,080.32
|
| Rate for Payer: First Health Commercial |
$8,103.98
|
| Rate for Payer: Humana Commercial |
$7,250.92
|
| Rate for Payer: Humana KY Medicaid |
$2,933.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,963.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,995.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,706.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.46
|
| Rate for Payer: PHCS Commercial |
$8,189.28
|
| Rate for Payer: United Healthcare All Payer |
$7,506.84
|
|
|
STENT ESOPH LRG 23*7CM COVERED
|
Facility
|
IP
|
$8,530.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.96 |
| Max. Negotiated Rate |
$8,189.28 |
| Rate for Payer: Aetna Commercial |
$6,568.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.79
|
| Rate for Payer: Cash Price |
$4,265.25
|
| Rate for Payer: Cigna Commercial |
$7,080.32
|
| Rate for Payer: First Health Commercial |
$8,103.98
|
| Rate for Payer: Humana Commercial |
$7,250.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,995.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,706.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.46
|
| Rate for Payer: PHCS Commercial |
$8,189.28
|
| Rate for Payer: United Healthcare All Payer |
$7,506.84
|
|
|
STENT ESOPH LRG 23*9CM COVERED
|
Facility
|
IP
|
$8,530.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.96 |
| Max. Negotiated Rate |
$8,189.28 |
| Rate for Payer: Aetna Commercial |
$6,568.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.79
|
| Rate for Payer: Cash Price |
$4,265.25
|
| Rate for Payer: Cigna Commercial |
$7,080.32
|
| Rate for Payer: First Health Commercial |
$8,103.98
|
| Rate for Payer: Humana Commercial |
$7,250.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,995.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,706.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.46
|
| Rate for Payer: PHCS Commercial |
$8,189.28
|
| Rate for Payer: United Healthcare All Payer |
$7,506.84
|
|
|
STENT ESOPH LRG 23*9CM COVERED
|
Facility
|
OP
|
$8,530.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.96 |
| Max. Negotiated Rate |
$8,189.28 |
| Rate for Payer: Aetna Commercial |
$6,568.48
|
| Rate for Payer: Anthem Medicaid |
$2,933.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.79
|
| Rate for Payer: Cash Price |
$4,265.25
|
| Rate for Payer: Cigna Commercial |
$7,080.32
|
| Rate for Payer: First Health Commercial |
$8,103.98
|
| Rate for Payer: Humana Commercial |
$7,250.92
|
| Rate for Payer: Humana KY Medicaid |
$2,933.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,963.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,995.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,706.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.46
|
| Rate for Payer: PHCS Commercial |
$8,189.28
|
| Rate for Payer: United Healthcare All Payer |
$7,506.84
|
|
|
STENT ESO WALLFLEX 23M*15.5CM
|
Facility
|
OP
|
$12,886.73
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.27 |
| Max. Negotiated Rate |
$12,371.26 |
| Rate for Payer: Aetna Commercial |
$9,922.78
|
| Rate for Payer: Anthem Medicaid |
$4,431.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,051.65
|
| Rate for Payer: Cash Price |
$6,443.36
|
| Rate for Payer: Cigna Commercial |
$10,695.99
|
| Rate for Payer: First Health Commercial |
$12,242.39
|
| Rate for Payer: Humana Commercial |
$10,953.72
|
| Rate for Payer: Humana KY Medicaid |
$4,431.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,476.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,567.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,510.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,866.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,520.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,340.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,665.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,577.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.89
|
| Rate for Payer: PHCS Commercial |
$12,371.26
|
| Rate for Payer: United Healthcare All Payer |
$11,340.32
|
|
|
STENT ESO WALLFLEX 23M*15.5CM
|
Facility
|
IP
|
$12,886.73
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.27 |
| Max. Negotiated Rate |
$12,371.26 |
| Rate for Payer: Aetna Commercial |
$9,922.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,051.65
|
| Rate for Payer: Cash Price |
$6,443.36
|
| Rate for Payer: Cigna Commercial |
$10,695.99
|
| Rate for Payer: First Health Commercial |
$12,242.39
|
| Rate for Payer: Humana Commercial |
$10,953.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,567.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,510.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,866.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,340.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,665.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,577.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.89
|
| Rate for Payer: PHCS Commercial |
$12,371.26
|
| Rate for Payer: United Healthcare All Payer |
$11,340.32
|
|
|
STENT EXPRESS LD 10MM*25MM
|
Facility
|
OP
|
$6,959.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.74 |
| Max. Negotiated Rate |
$6,681.16 |
| Rate for Payer: Aetna Commercial |
$5,358.85
|
| Rate for Payer: Anthem Medicaid |
$2,393.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,428.44
|
| Rate for Payer: Cash Price |
$3,479.77
|
| Rate for Payer: Cigna Commercial |
$5,776.42
|
| Rate for Payer: First Health Commercial |
$6,611.56
|
| Rate for Payer: Humana Commercial |
$5,915.61
|
| Rate for Payer: Humana KY Medicaid |
$2,393.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,417.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,706.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,136.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,124.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,219.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.46
|
| Rate for Payer: PHCS Commercial |
$6,681.16
|
| Rate for Payer: United Healthcare All Payer |
$6,124.40
|
|
|
STENT EXPRESS LD 10MM*25MM
|
Facility
|
IP
|
$6,959.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.74 |
| Max. Negotiated Rate |
$6,681.16 |
| Rate for Payer: Aetna Commercial |
$5,358.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,428.44
|
| Rate for Payer: Cash Price |
$3,479.77
|
| Rate for Payer: Cigna Commercial |
$5,776.42
|
| Rate for Payer: First Health Commercial |
$6,611.56
|
| Rate for Payer: Humana Commercial |
$5,915.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,706.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,136.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,124.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,219.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.46
|
| Rate for Payer: PHCS Commercial |
$6,681.16
|
| Rate for Payer: United Healthcare All Payer |
$6,124.40
|
|
|
STENT EXPRESS LD 10MM*37MM
|
Facility
|
OP
|
$7,280.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$6,989.51 |
| Rate for Payer: Aetna Commercial |
$5,606.17
|
| Rate for Payer: Anthem Medicaid |
$2,503.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,678.98
|
| Rate for Payer: Cash Price |
$3,640.37
|
| Rate for Payer: Cigna Commercial |
$6,043.01
|
| Rate for Payer: First Health Commercial |
$6,916.70
|
| Rate for Payer: Humana Commercial |
$6,188.63
|
| Rate for Payer: Humana KY Medicaid |
$2,503.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,529.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,970.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,373.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,554.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,407.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,460.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,257.03
|
| Rate for Payer: PHCS Commercial |
$6,989.51
|
| Rate for Payer: United Healthcare All Payer |
$6,407.05
|
|
|
STENT EXPRESS LD 10MM*37MM
|
Facility
|
IP
|
$7,280.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$6,989.51 |
| Rate for Payer: Aetna Commercial |
$5,606.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,678.98
|
| Rate for Payer: Cash Price |
$3,640.37
|
| Rate for Payer: Cigna Commercial |
$6,043.01
|
| Rate for Payer: First Health Commercial |
$6,916.70
|
| Rate for Payer: Humana Commercial |
$6,188.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,970.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,373.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,407.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,460.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,257.03
|
| Rate for Payer: PHCS Commercial |
$6,989.51
|
| Rate for Payer: United Healthcare All Payer |
$6,407.05
|
|
|
STENT EXPRESS LD 6*17*135
|
Facility
|
OP
|
$6,959.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.74 |
| Max. Negotiated Rate |
$6,681.16 |
| Rate for Payer: Aetna Commercial |
$5,358.85
|
| Rate for Payer: Anthem Medicaid |
$2,393.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,428.44
|
| Rate for Payer: Cash Price |
$3,479.77
|
| Rate for Payer: Cigna Commercial |
$5,776.42
|
| Rate for Payer: First Health Commercial |
$6,611.56
|
| Rate for Payer: Humana Commercial |
$5,915.61
|
| Rate for Payer: Humana KY Medicaid |
$2,393.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,417.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,706.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,136.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,441.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,124.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,219.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.46
|
| Rate for Payer: PHCS Commercial |
$6,681.16
|
| Rate for Payer: United Healthcare All Payer |
$6,124.40
|
|
|
STENT EXPRESS LD 6*17*135
|
Facility
|
IP
|
$6,959.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.74 |
| Max. Negotiated Rate |
$6,681.16 |
| Rate for Payer: Aetna Commercial |
$5,358.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,428.44
|
| Rate for Payer: Cash Price |
$3,479.77
|
| Rate for Payer: Cigna Commercial |
$5,776.42
|
| Rate for Payer: First Health Commercial |
$6,611.56
|
| Rate for Payer: Humana Commercial |
$5,915.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,706.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,136.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,124.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,219.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,157.46
|
| Rate for Payer: PHCS Commercial |
$6,681.16
|
| Rate for Payer: United Healthcare All Payer |
$6,124.40
|
|
|
STENT EXPRESS LD 6MM*17MM
|
Facility
|
OP
|
$7,054.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.03 |
| Max. Negotiated Rate |
$6,771.92 |
| Rate for Payer: Aetna Commercial |
$5,431.64
|
| Rate for Payer: Anthem Medicaid |
$2,425.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,502.18
|
| Rate for Payer: Cash Price |
$3,527.04
|
| Rate for Payer: Cigna Commercial |
$5,854.89
|
| Rate for Payer: First Health Commercial |
$6,701.38
|
| Rate for Payer: Humana Commercial |
$5,995.97
|
| Rate for Payer: Humana KY Medicaid |
$2,425.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,450.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,784.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,205.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,474.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,207.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,290.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,186.76
|
| Rate for Payer: PHCS Commercial |
$6,771.92
|
| Rate for Payer: United Healthcare All Payer |
$6,207.59
|
|
|
STENT EXPRESS LD 6MM*17MM
|
Facility
|
IP
|
$7,054.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.03 |
| Max. Negotiated Rate |
$6,771.92 |
| Rate for Payer: Aetna Commercial |
$5,431.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,502.18
|
| Rate for Payer: Cash Price |
$3,527.04
|
| Rate for Payer: Cigna Commercial |
$5,854.89
|
| Rate for Payer: First Health Commercial |
$6,701.38
|
| Rate for Payer: Humana Commercial |
$5,995.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,784.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,205.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,207.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,290.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,186.76
|
| Rate for Payer: PHCS Commercial |
$6,771.92
|
| Rate for Payer: United Healthcare All Payer |
$6,207.59
|
|
|
STENT EXPRESS LD 6MM*27MM
|
Facility
|
IP
|
$7,280.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$6,989.51 |
| Rate for Payer: Aetna Commercial |
$5,606.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,678.98
|
| Rate for Payer: Cash Price |
$3,640.37
|
| Rate for Payer: Cigna Commercial |
$6,043.01
|
| Rate for Payer: First Health Commercial |
$6,916.70
|
| Rate for Payer: Humana Commercial |
$6,188.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,970.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,373.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,407.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,460.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,257.03
|
| Rate for Payer: PHCS Commercial |
$6,989.51
|
| Rate for Payer: United Healthcare All Payer |
$6,407.05
|
|
|
STENT EXPRESS LD 6MM*27MM
|
Facility
|
OP
|
$7,280.74
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$6,989.51 |
| Rate for Payer: Aetna Commercial |
$5,606.17
|
| Rate for Payer: Anthem Medicaid |
$2,503.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,678.98
|
| Rate for Payer: Cash Price |
$3,640.37
|
| Rate for Payer: Cigna Commercial |
$6,043.01
|
| Rate for Payer: First Health Commercial |
$6,916.70
|
| Rate for Payer: Humana Commercial |
$6,188.63
|
| Rate for Payer: Humana KY Medicaid |
$2,503.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,529.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,970.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,373.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,184.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,554.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,407.05
|
| Rate for Payer: Ohio Health Group HMO |
$5,460.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,257.03
|
| Rate for Payer: PHCS Commercial |
$6,989.51
|
| Rate for Payer: United Healthcare All Payer |
$6,407.05
|
|
|
STENT EXPRESS LD 6MM*37MM
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
STENT EXPRESS LD 6MM*37MM
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
STENT EXPRESS LD 6MM*57MM
|
Facility
|
IP
|
$7,601.94
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.25 |
| Max. Negotiated Rate |
$7,297.86 |
| Rate for Payer: Aetna Commercial |
$5,853.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,929.51
|
| Rate for Payer: Cash Price |
$3,800.97
|
| Rate for Payer: Cigna Commercial |
$6,309.61
|
| Rate for Payer: First Health Commercial |
$7,221.84
|
| Rate for Payer: Humana Commercial |
$6,461.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,233.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,610.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,280.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,689.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,701.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.60
|
| Rate for Payer: PHCS Commercial |
$7,297.86
|
| Rate for Payer: United Healthcare All Payer |
$6,689.71
|
|
