|
STENT DBL PIGTAIL 6FR*26CM
|
Facility
|
OP
|
$1,756.72
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.02 |
| Max. Negotiated Rate |
$1,686.45 |
| Rate for Payer: Aetna Commercial |
$1,352.67
|
| Rate for Payer: Anthem Medicaid |
$604.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,370.24
|
| Rate for Payer: Cash Price |
$878.36
|
| Rate for Payer: Cigna Commercial |
$1,458.08
|
| Rate for Payer: First Health Commercial |
$1,668.88
|
| Rate for Payer: Humana Commercial |
$1,493.21
|
| Rate for Payer: Humana KY Medicaid |
$604.14
|
| Rate for Payer: Kentucky WC Medicaid |
$610.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,440.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,296.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.14
|
| Rate for Payer: PHCS Commercial |
$1,686.45
|
| Rate for Payer: United Healthcare All Payer |
$1,545.91
|
|
|
STENT DOUBLE J 6*20CM
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem Medicaid |
$630.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Humana KY Medicaid |
$630.02
|
| Rate for Payer: Kentucky WC Medicaid |
$636.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
STENT DOUBLE J 6*20CM
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
STENT DUMON STYLE Y 14*10*10
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 14*10*10
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 15*12*12
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 15*12*12
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 16*13*13
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 16*13*13
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 18*14*14
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DUMON STYLE Y 18*14*14
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
STENT DYNAMIC Y 13*10
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
STENT DYNAMIC Y 13*10
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
STENT DYNAMIC Y 15*12
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
STENT DYNAMIC Y 15*12
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1875
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
STENT ESOPH 7CM COVERED
|
Facility
|
OP
|
$8,566.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.88 |
| Max. Negotiated Rate |
$8,223.60 |
| Rate for Payer: Aetna Commercial |
$6,596.01
|
| Rate for Payer: Anthem Medicaid |
$2,945.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.68
|
| Rate for Payer: Cash Price |
$4,283.12
|
| Rate for Payer: Cigna Commercial |
$7,109.99
|
| Rate for Payer: First Health Commercial |
$8,137.94
|
| Rate for Payer: Humana Commercial |
$7,281.31
|
| Rate for Payer: Humana KY Medicaid |
$2,945.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,975.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,321.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,853.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,452.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,910.71
|
| Rate for Payer: PHCS Commercial |
$8,223.60
|
| Rate for Payer: United Healthcare All Payer |
$7,538.30
|
|
|
STENT ESOPH 7CM COVERED
|
Facility
|
IP
|
$8,566.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.88 |
| Max. Negotiated Rate |
$8,223.60 |
| Rate for Payer: Aetna Commercial |
$6,596.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.68
|
| Rate for Payer: Cash Price |
$4,283.12
|
| Rate for Payer: Cigna Commercial |
$7,109.99
|
| Rate for Payer: First Health Commercial |
$8,137.94
|
| Rate for Payer: Humana Commercial |
$7,281.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,321.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,853.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,452.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,910.71
|
| Rate for Payer: PHCS Commercial |
$8,223.60
|
| Rate for Payer: United Healthcare All Payer |
$7,538.30
|
|
|
STENT ESOPH 9CM COVERED
|
Facility
|
IP
|
$8,566.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.88 |
| Max. Negotiated Rate |
$8,223.60 |
| Rate for Payer: Aetna Commercial |
$6,596.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.68
|
| Rate for Payer: Cash Price |
$4,283.12
|
| Rate for Payer: Cigna Commercial |
$7,109.99
|
| Rate for Payer: First Health Commercial |
$8,137.94
|
| Rate for Payer: Humana Commercial |
$7,281.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,321.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,853.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,452.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,910.71
|
| Rate for Payer: PHCS Commercial |
$8,223.60
|
| Rate for Payer: United Healthcare All Payer |
$7,538.30
|
|
|
STENT ESOPH 9CM COVERED
|
Facility
|
OP
|
$8,566.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.88 |
| Max. Negotiated Rate |
$8,223.60 |
| Rate for Payer: Aetna Commercial |
$6,596.01
|
| Rate for Payer: Anthem Medicaid |
$2,945.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.68
|
| Rate for Payer: Cash Price |
$4,283.12
|
| Rate for Payer: Cigna Commercial |
$7,109.99
|
| Rate for Payer: First Health Commercial |
$8,137.94
|
| Rate for Payer: Humana Commercial |
$7,281.31
|
| Rate for Payer: Humana KY Medicaid |
$2,945.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,975.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,321.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,853.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,452.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,910.71
|
| Rate for Payer: PHCS Commercial |
$8,223.60
|
| Rate for Payer: United Healthcare All Payer |
$7,538.30
|
|
|
STENT ESOPH LRG 23*7CM COVERED
|
Facility
|
OP
|
$8,730.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.15 |
| Max. Negotiated Rate |
$8,381.28 |
| Rate for Payer: Aetna Commercial |
$6,722.48
|
| Rate for Payer: Anthem Medicaid |
$3,002.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,809.79
|
| Rate for Payer: Cash Price |
$4,365.25
|
| Rate for Payer: Cigna Commercial |
$7,246.31
|
| Rate for Payer: First Health Commercial |
$8,293.98
|
| Rate for Payer: Humana Commercial |
$7,420.93
|
| Rate for Payer: Humana KY Medicaid |
$3,002.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,032.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,062.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,682.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,547.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,984.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,595.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,024.05
|
| Rate for Payer: PHCS Commercial |
$8,381.28
|
| Rate for Payer: United Healthcare All Payer |
$7,682.84
|
|
|
STENT ESOPH LRG 23*7CM COVERED
|
Facility
|
IP
|
$8,730.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.15 |
| Max. Negotiated Rate |
$8,381.28 |
| Rate for Payer: Aetna Commercial |
$6,722.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,809.79
|
| Rate for Payer: Cash Price |
$4,365.25
|
| Rate for Payer: Cigna Commercial |
$7,246.31
|
| Rate for Payer: First Health Commercial |
$8,293.98
|
| Rate for Payer: Humana Commercial |
$7,420.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,682.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,547.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,984.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,595.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,024.05
|
| Rate for Payer: PHCS Commercial |
$8,381.28
|
| Rate for Payer: United Healthcare All Payer |
$7,682.84
|
|
|
STENT ESOPH LRG 23*9CM COVERED
|
Facility
|
OP
|
$8,730.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.15 |
| Max. Negotiated Rate |
$8,381.28 |
| Rate for Payer: Aetna Commercial |
$6,722.48
|
| Rate for Payer: Anthem Medicaid |
$3,002.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,809.79
|
| Rate for Payer: Cash Price |
$4,365.25
|
| Rate for Payer: Cigna Commercial |
$7,246.31
|
| Rate for Payer: First Health Commercial |
$8,293.98
|
| Rate for Payer: Humana Commercial |
$7,420.93
|
| Rate for Payer: Humana KY Medicaid |
$3,002.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,032.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,062.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,682.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,547.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,984.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,595.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,024.05
|
| Rate for Payer: PHCS Commercial |
$8,381.28
|
| Rate for Payer: United Healthcare All Payer |
$7,682.84
|
|
|
STENT ESOPH LRG 23*9CM COVERED
|
Facility
|
IP
|
$8,730.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.15 |
| Max. Negotiated Rate |
$8,381.28 |
| Rate for Payer: Aetna Commercial |
$6,722.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,809.79
|
| Rate for Payer: Cash Price |
$4,365.25
|
| Rate for Payer: Cigna Commercial |
$7,246.31
|
| Rate for Payer: First Health Commercial |
$8,293.98
|
| Rate for Payer: Humana Commercial |
$7,420.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,682.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,547.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,984.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,595.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,024.05
|
| Rate for Payer: PHCS Commercial |
$8,381.28
|
| Rate for Payer: United Healthcare All Payer |
$7,682.84
|
|
|
STENT ESO WALLFLEX 23M*15.5CM
|
Facility
|
OP
|
$13,139.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.78 |
| Max. Negotiated Rate |
$12,613.68 |
| Rate for Payer: Aetna Commercial |
$10,117.22
|
| Rate for Payer: Anthem Medicaid |
$4,518.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,248.61
|
| Rate for Payer: Cash Price |
$6,569.63
|
| Rate for Payer: Cigna Commercial |
$10,905.58
|
| Rate for Payer: First Health Commercial |
$12,482.29
|
| Rate for Payer: Humana Commercial |
$11,168.36
|
| Rate for Payer: Humana KY Medicaid |
$4,518.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,564.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,774.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,696.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,609.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,562.54
|
| Rate for Payer: Ohio Health Group HMO |
$9,854.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,511.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,431.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,066.08
|
| Rate for Payer: PHCS Commercial |
$12,613.68
|
| Rate for Payer: United Healthcare All Payer |
$11,562.54
|
|
|
STENT ESO WALLFLEX 23M*15.5CM
|
Facility
|
IP
|
$13,139.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.78 |
| Max. Negotiated Rate |
$12,613.68 |
| Rate for Payer: Aetna Commercial |
$10,117.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,248.61
|
| Rate for Payer: Cash Price |
$6,569.63
|
| Rate for Payer: Cigna Commercial |
$10,905.58
|
| Rate for Payer: First Health Commercial |
$12,482.29
|
| Rate for Payer: Humana Commercial |
$11,168.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,774.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,696.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,562.54
|
| Rate for Payer: Ohio Health Group HMO |
$9,854.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,511.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,431.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,066.08
|
| Rate for Payer: PHCS Commercial |
$12,613.68
|
| Rate for Payer: United Healthcare All Payer |
$11,562.54
|
|
