|
STENT WALLFLEX 25*90MM 10FR
|
Facility
|
OP
|
$13,035.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,694.63 |
| Max. Negotiated Rate |
$12,514.22 |
| Rate for Payer: Aetna Commercial |
$10,037.45
|
| Rate for Payer: Anthem Medicaid |
$4,482.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,167.81
|
| Rate for Payer: Cash Price |
$6,517.82
|
| Rate for Payer: Cigna Commercial |
$10,819.59
|
| Rate for Payer: First Health Commercial |
$12,383.87
|
| Rate for Payer: Humana Commercial |
$11,080.30
|
| Rate for Payer: Humana KY Medicaid |
$4,482.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,528.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,620.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,910.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,572.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,471.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,776.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,607.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,694.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,041.05
|
| Rate for Payer: PHCS Commercial |
$12,514.22
|
| Rate for Payer: United Healthcare All Payer |
$11,471.37
|
|
|
STENT WALLFLEX BIL 8MM*100MM
|
Facility
|
IP
|
$9,515.38
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$9,134.76 |
| Rate for Payer: Aetna Commercial |
$7,326.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.00
|
| Rate for Payer: Cash Price |
$4,757.69
|
| Rate for Payer: Cigna Commercial |
$7,897.77
|
| Rate for Payer: First Health Commercial |
$9,039.61
|
| Rate for Payer: Humana Commercial |
$8,088.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.77
|
| Rate for Payer: PHCS Commercial |
$9,134.76
|
| Rate for Payer: United Healthcare All Payer |
$8,373.53
|
|
|
STENT WALLFLEX BIL 8MM*100MM
|
Facility
|
OP
|
$9,515.38
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$9,134.76 |
| Rate for Payer: Aetna Commercial |
$7,326.84
|
| Rate for Payer: Anthem Medicaid |
$3,272.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.00
|
| Rate for Payer: Cash Price |
$4,757.69
|
| Rate for Payer: Cigna Commercial |
$7,897.77
|
| Rate for Payer: First Health Commercial |
$9,039.61
|
| Rate for Payer: Humana Commercial |
$8,088.07
|
| Rate for Payer: Humana KY Medicaid |
$3,272.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,338.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.77
|
| Rate for Payer: PHCS Commercial |
$9,134.76
|
| Rate for Payer: United Healthcare All Payer |
$8,373.53
|
|
|
STENT WALLFLEX ESOPH 18*15.3
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
STENT WALLFLEX ESOPH 18*15.3
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
STENT WALLFLEX ESOPH FC 23*10
|
Facility
|
OP
|
$12,046.09
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.99 |
| Max. Negotiated Rate |
$11,564.25 |
| Rate for Payer: Aetna Commercial |
$9,275.49
|
| Rate for Payer: Anthem Medicaid |
$4,142.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,395.95
|
| Rate for Payer: Cash Price |
$6,023.05
|
| Rate for Payer: Cigna Commercial |
$9,998.25
|
| Rate for Payer: First Health Commercial |
$11,443.79
|
| Rate for Payer: Humana Commercial |
$10,239.18
|
| Rate for Payer: Humana KY Medicaid |
$4,142.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,184.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,877.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,890.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,613.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,225.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,600.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,034.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,734.29
|
| Rate for Payer: PHCS Commercial |
$11,564.25
|
| Rate for Payer: United Healthcare All Payer |
$10,600.56
|
|
|
STENT WALLFLEX ESOPH FC 23*10
|
Facility
|
IP
|
$12,046.09
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.99 |
| Max. Negotiated Rate |
$11,564.25 |
| Rate for Payer: Aetna Commercial |
$9,275.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,395.95
|
| Rate for Payer: Cash Price |
$6,023.05
|
| Rate for Payer: Cigna Commercial |
$9,998.25
|
| Rate for Payer: First Health Commercial |
$11,443.79
|
| Rate for Payer: Humana Commercial |
$10,239.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,877.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,890.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,613.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,600.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,034.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,734.29
|
| Rate for Payer: PHCS Commercial |
$11,564.25
|
| Rate for Payer: United Healthcare All Payer |
$10,600.56
|
|
|
STENT WALLFLEX ESOPH FC 23*10.
|
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 WALLFLEX ESOPH FC 23*10.
|
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 WALLFLEX ESOPH FC 23*12.
|
Facility
|
IP
|
$12,046.09
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.99 |
| Max. Negotiated Rate |
$11,564.25 |
| Rate for Payer: Aetna Commercial |
$9,275.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,395.95
|
| Rate for Payer: Cash Price |
$6,023.05
|
| Rate for Payer: Cigna Commercial |
$9,998.25
|
| Rate for Payer: First Health Commercial |
$11,443.79
|
| Rate for Payer: Humana Commercial |
$10,239.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,877.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,890.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,613.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,600.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,034.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,734.29
|
| Rate for Payer: PHCS Commercial |
$11,564.25
|
| Rate for Payer: United Healthcare All Payer |
$10,600.56
|
|
|
STENT WALLFLEX ESOPH FC 23*12.
|
Facility
|
OP
|
$12,046.09
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.99 |
| Max. Negotiated Rate |
$11,564.25 |
| Rate for Payer: Aetna Commercial |
$9,275.49
|
| Rate for Payer: Anthem Medicaid |
$4,142.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,395.95
|
| Rate for Payer: Cash Price |
$6,023.05
|
| Rate for Payer: Cigna Commercial |
$9,998.25
|
| Rate for Payer: First Health Commercial |
$11,443.79
|
| Rate for Payer: Humana Commercial |
$10,239.18
|
| Rate for Payer: Humana KY Medicaid |
$4,142.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,184.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,877.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,890.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,613.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,225.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,600.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,034.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,734.29
|
| Rate for Payer: PHCS Commercial |
$11,564.25
|
| Rate for Payer: United Healthcare All Payer |
$10,600.56
|
|
|
STENT WALLFLEX ESOPH PC 18*12
|
Facility
|
OP
|
$12,516.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,627.11 |
| Max. Negotiated Rate |
$12,015.60 |
| Rate for Payer: Aetna Commercial |
$9,637.51
|
| Rate for Payer: Anthem Medicaid |
$4,304.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,762.68
|
| Rate for Payer: Cash Price |
$6,258.12
|
| Rate for Payer: Cigna Commercial |
$10,388.49
|
| Rate for Payer: First Health Commercial |
$11,890.44
|
| Rate for Payer: Humana Commercial |
$10,638.81
|
| Rate for Payer: Humana KY Medicaid |
$4,304.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,348.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,263.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,236.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,754.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,014.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,387.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,627.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,880.04
|
| Rate for Payer: PHCS Commercial |
$12,015.60
|
| Rate for Payer: United Healthcare All Payer |
$11,014.30
|
|
|
STENT WALLFLEX ESOPH PC 18*12
|
Facility
|
IP
|
$12,516.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,627.11 |
| Max. Negotiated Rate |
$12,015.60 |
| Rate for Payer: Aetna Commercial |
$9,637.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,762.68
|
| Rate for Payer: Cash Price |
$6,258.12
|
| Rate for Payer: Cigna Commercial |
$10,388.49
|
| Rate for Payer: First Health Commercial |
$11,890.44
|
| Rate for Payer: Humana Commercial |
$10,638.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,263.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,236.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,754.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,014.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,387.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,627.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,880.04
|
| Rate for Payer: PHCS Commercial |
$12,015.60
|
| Rate for Payer: United Healthcare All Payer |
$11,014.30
|
|
|
STENT WALLFLEX ESOPH PC 23*12
|
Facility
|
OP
|
$12,626.11
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,641.39 |
| Max. Negotiated Rate |
$12,121.07 |
| Rate for Payer: Aetna Commercial |
$9,722.10
|
| Rate for Payer: Anthem Medicaid |
$4,342.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,848.37
|
| Rate for Payer: Cash Price |
$6,313.06
|
| Rate for Payer: Cigna Commercial |
$10,479.67
|
| Rate for Payer: First Health Commercial |
$11,994.80
|
| Rate for Payer: Humana Commercial |
$10,732.19
|
| Rate for Payer: Humana KY Medicaid |
$4,342.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,386.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,353.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,318.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,787.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,110.98
|
| Rate for Payer: Ohio Health Group HMO |
$9,469.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,525.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,641.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,914.09
|
| Rate for Payer: PHCS Commercial |
$12,121.07
|
| Rate for Payer: United Healthcare All Payer |
$11,110.98
|
|
|
STENT WALLFLEX ESOPH PC 23*12
|
Facility
|
IP
|
$12,626.11
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,641.39 |
| Max. Negotiated Rate |
$12,121.07 |
| Rate for Payer: Aetna Commercial |
$9,722.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,848.37
|
| Rate for Payer: Cash Price |
$6,313.06
|
| Rate for Payer: Cigna Commercial |
$10,479.67
|
| Rate for Payer: First Health Commercial |
$11,994.80
|
| Rate for Payer: Humana Commercial |
$10,732.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,353.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,318.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,787.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,110.98
|
| Rate for Payer: Ohio Health Group HMO |
$9,469.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,525.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,641.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,914.09
|
| Rate for Payer: PHCS Commercial |
$12,121.07
|
| Rate for Payer: United Healthcare All Payer |
$11,110.98
|
|
|
STENT WALLFLX BIL COVERED 8*60
|
Facility
|
OP
|
$12,698.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.84 |
| Max. Negotiated Rate |
$12,190.80 |
| Rate for Payer: Aetna Commercial |
$9,778.04
|
| Rate for Payer: Anthem Medicaid |
$4,367.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,905.02
|
| Rate for Payer: Cash Price |
$6,349.38
|
| Rate for Payer: Cigna Commercial |
$10,539.96
|
| Rate for Payer: First Health Commercial |
$12,063.81
|
| Rate for Payer: Humana Commercial |
$10,793.94
|
| Rate for Payer: Humana KY Medicaid |
$4,367.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,411.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,412.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,371.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,809.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,174.90
|
| Rate for Payer: Ohio Health Group HMO |
$9,524.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,539.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,936.61
|
| Rate for Payer: PHCS Commercial |
$12,190.80
|
| Rate for Payer: United Healthcare All Payer |
$11,174.90
|
|
|
STENT WALLFLX BIL COVERED 8*60
|
Facility
|
IP
|
$12,698.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.84 |
| Max. Negotiated Rate |
$12,190.80 |
| Rate for Payer: Aetna Commercial |
$9,778.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,905.02
|
| Rate for Payer: Cash Price |
$6,349.38
|
| Rate for Payer: Cigna Commercial |
$10,539.96
|
| Rate for Payer: First Health Commercial |
$12,063.81
|
| Rate for Payer: Humana Commercial |
$10,793.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,412.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,371.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,809.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,174.90
|
| Rate for Payer: Ohio Health Group HMO |
$9,524.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,539.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,936.61
|
| Rate for Payer: PHCS Commercial |
$12,190.80
|
| Rate for Payer: United Healthcare All Payer |
$11,174.90
|
|
|
STENT WALLFLX ESOPH PC 23*10.5
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
STENT WALLFLX ESOPH PC 23*10.5
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
STENT WALLGRAFT 10*20 COVERED
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT WALLGRAFT 10*20 COVERED
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT WALLGRAFT 10*30 COVERED
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT WALLGRAFT 10*30 COVERED
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
STENT WALLGRAFT 10*70 COVERED
|
Facility
|
OP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem Medicaid |
$3,959.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Humana KY Medicaid |
$3,959.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,999.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,038.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
STENT WALLGRAFT 10*70 COVERED
|
Facility
|
IP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
