|
STENT WALLFLEX BIL 8MM*100MM
|
Facility
|
OP
|
$9,715.38
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.61 |
| Max. Negotiated Rate |
$9,326.76 |
| Rate for Payer: Aetna Commercial |
$7,480.84
|
| Rate for Payer: Anthem Medicaid |
$3,341.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.00
|
| Rate for Payer: Cash Price |
$4,857.69
|
| Rate for Payer: Cigna Commercial |
$8,063.77
|
| Rate for Payer: First Health Commercial |
$9,229.61
|
| Rate for Payer: Humana Commercial |
$8,258.07
|
| Rate for Payer: Humana KY Medicaid |
$3,341.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,966.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,169.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,549.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,286.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,703.61
|
| Rate for Payer: PHCS Commercial |
$9,326.76
|
| Rate for Payer: United Healthcare All Payer |
$8,549.53
|
|
|
STENT WALLFLEX ESOPH 18*15.3
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
STENT WALLFLEX ESOPH 18*15.3
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
STENT WALLFLEX ESOPH FC 23*10
|
Facility
|
OP
|
$12,294.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,688.21 |
| Max. Negotiated Rate |
$11,802.26 |
| Rate for Payer: Aetna Commercial |
$9,466.40
|
| Rate for Payer: Anthem Medicaid |
$4,227.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,589.34
|
| Rate for Payer: Cash Price |
$6,147.01
|
| Rate for Payer: Cigna Commercial |
$10,204.04
|
| Rate for Payer: First Health Commercial |
$11,679.32
|
| Rate for Payer: Humana Commercial |
$10,449.92
|
| Rate for Payer: Humana KY Medicaid |
$4,227.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,081.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,072.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,688.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,312.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,818.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,220.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,835.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,695.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,482.87
|
| Rate for Payer: PHCS Commercial |
$11,802.26
|
| Rate for Payer: United Healthcare All Payer |
$10,818.74
|
|
|
STENT WALLFLEX ESOPH FC 23*10
|
Facility
|
IP
|
$12,294.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,688.21 |
| Max. Negotiated Rate |
$11,802.26 |
| Rate for Payer: Aetna Commercial |
$9,466.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,589.34
|
| Rate for Payer: Cash Price |
$6,147.01
|
| Rate for Payer: Cigna Commercial |
$10,204.04
|
| Rate for Payer: First Health Commercial |
$11,679.32
|
| Rate for Payer: Humana Commercial |
$10,449.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,081.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,072.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,688.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,818.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,220.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,835.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,695.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,482.87
|
| Rate for Payer: PHCS Commercial |
$11,802.26
|
| Rate for Payer: United Healthcare All Payer |
$10,818.74
|
|
|
STENT WALLFLEX ESOPH FC 23*10.
|
Facility
|
IP
|
$12,294.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,688.21 |
| Max. Negotiated Rate |
$11,802.26 |
| Rate for Payer: Aetna Commercial |
$9,466.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,589.34
|
| Rate for Payer: Cash Price |
$6,147.01
|
| Rate for Payer: Cigna Commercial |
$10,204.04
|
| Rate for Payer: First Health Commercial |
$11,679.32
|
| Rate for Payer: Humana Commercial |
$10,449.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,081.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,072.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,688.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,818.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,220.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,835.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,695.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,482.87
|
| Rate for Payer: PHCS Commercial |
$11,802.26
|
| Rate for Payer: United Healthcare All Payer |
$10,818.74
|
|
|
STENT WALLFLEX ESOPH FC 23*10.
|
Facility
|
OP
|
$12,294.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,688.21 |
| Max. Negotiated Rate |
$11,802.26 |
| Rate for Payer: Aetna Commercial |
$9,466.40
|
| Rate for Payer: Anthem Medicaid |
$4,227.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,589.34
|
| Rate for Payer: Cash Price |
$6,147.01
|
| Rate for Payer: Cigna Commercial |
$10,204.04
|
| Rate for Payer: First Health Commercial |
$11,679.32
|
| Rate for Payer: Humana Commercial |
$10,449.92
|
| Rate for Payer: Humana KY Medicaid |
$4,227.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,081.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,072.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,688.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,312.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,818.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,220.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,835.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,695.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,482.87
|
| Rate for Payer: PHCS Commercial |
$11,802.26
|
| Rate for Payer: United Healthcare All Payer |
$10,818.74
|
|
|
STENT WALLFLEX ESOPH FC 23*12.
|
Facility
|
IP
|
$12,294.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,688.21 |
| Max. Negotiated Rate |
$11,802.26 |
| Rate for Payer: Aetna Commercial |
$9,466.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,589.34
|
| Rate for Payer: Cash Price |
$6,147.01
|
| Rate for Payer: Cigna Commercial |
$10,204.04
|
| Rate for Payer: First Health Commercial |
$11,679.32
|
| Rate for Payer: Humana Commercial |
$10,449.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,081.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,072.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,688.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,818.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,220.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,835.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,695.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,482.87
|
| Rate for Payer: PHCS Commercial |
$11,802.26
|
| Rate for Payer: United Healthcare All Payer |
$10,818.74
|
|
|
STENT WALLFLEX ESOPH FC 23*12.
|
Facility
|
OP
|
$12,294.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,688.21 |
| Max. Negotiated Rate |
$11,802.26 |
| Rate for Payer: Aetna Commercial |
$9,466.40
|
| Rate for Payer: Anthem Medicaid |
$4,227.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,589.34
|
| Rate for Payer: Cash Price |
$6,147.01
|
| Rate for Payer: Cigna Commercial |
$10,204.04
|
| Rate for Payer: First Health Commercial |
$11,679.32
|
| Rate for Payer: Humana Commercial |
$10,449.92
|
| Rate for Payer: Humana KY Medicaid |
$4,227.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,081.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,072.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,688.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,312.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,818.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,220.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,835.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,695.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,482.87
|
| Rate for Payer: PHCS Commercial |
$11,802.26
|
| Rate for Payer: United Healthcare All Payer |
$10,818.74
|
|
|
STENT WALLFLEX ESOPH PC 18*12
|
Facility
|
IP
|
$12,766.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,830.03 |
| Max. Negotiated Rate |
$12,256.08 |
| Rate for Payer: Aetna Commercial |
$9,830.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,958.07
|
| Rate for Payer: Cash Price |
$6,383.38
|
| Rate for Payer: Cigna Commercial |
$10,596.40
|
| Rate for Payer: First Health Commercial |
$12,128.41
|
| Rate for Payer: Humana Commercial |
$10,851.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,468.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,421.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,830.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,234.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,575.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,213.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,107.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,809.06
|
| Rate for Payer: PHCS Commercial |
$12,256.08
|
| Rate for Payer: United Healthcare All Payer |
$11,234.74
|
|
|
STENT WALLFLEX ESOPH PC 18*12
|
Facility
|
OP
|
$12,766.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,830.03 |
| Max. Negotiated Rate |
$12,256.08 |
| Rate for Payer: Aetna Commercial |
$9,830.40
|
| Rate for Payer: Anthem Medicaid |
$4,390.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,958.07
|
| Rate for Payer: Cash Price |
$6,383.38
|
| Rate for Payer: Cigna Commercial |
$10,596.40
|
| Rate for Payer: First Health Commercial |
$12,128.41
|
| Rate for Payer: Humana Commercial |
$10,851.74
|
| Rate for Payer: Humana KY Medicaid |
$4,390.49
|
| Rate for Payer: Kentucky WC Medicaid |
$4,435.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,468.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,421.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,830.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,478.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,234.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,575.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,213.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,107.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,809.06
|
| Rate for Payer: PHCS Commercial |
$12,256.08
|
| Rate for Payer: United Healthcare All Payer |
$11,234.74
|
|
|
STENT WALLFLEX ESOPH PC 23*12
|
Facility
|
IP
|
$12,877.22
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,863.17 |
| Max. Negotiated Rate |
$12,362.13 |
| Rate for Payer: Aetna Commercial |
$9,915.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,044.23
|
| Rate for Payer: Cash Price |
$6,438.61
|
| Rate for Payer: Cigna Commercial |
$10,688.09
|
| Rate for Payer: First Health Commercial |
$12,233.36
|
| Rate for Payer: Humana Commercial |
$10,945.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,559.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,503.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,863.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,331.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,657.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,301.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,203.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,885.28
|
| Rate for Payer: PHCS Commercial |
$12,362.13
|
| Rate for Payer: United Healthcare All Payer |
$11,331.95
|
|
|
STENT WALLFLEX ESOPH PC 23*12
|
Facility
|
OP
|
$12,877.22
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,863.17 |
| Max. Negotiated Rate |
$12,362.13 |
| Rate for Payer: Aetna Commercial |
$9,915.46
|
| Rate for Payer: Anthem Medicaid |
$4,428.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,044.23
|
| Rate for Payer: Cash Price |
$6,438.61
|
| Rate for Payer: Cigna Commercial |
$10,688.09
|
| Rate for Payer: First Health Commercial |
$12,233.36
|
| Rate for Payer: Humana Commercial |
$10,945.64
|
| Rate for Payer: Humana KY Medicaid |
$4,428.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,473.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,559.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,503.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,863.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,517.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,331.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,657.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,301.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,203.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,885.28
|
| Rate for Payer: PHCS Commercial |
$12,362.13
|
| Rate for Payer: United Healthcare All Payer |
$11,331.95
|
|
|
STENT WALLFLX BIL COVERED 8*60
|
Facility
|
IP
|
$12,950.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,885.07 |
| Max. Negotiated Rate |
$12,432.24 |
| Rate for Payer: Aetna Commercial |
$9,971.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,101.19
|
| Rate for Payer: Cash Price |
$6,475.12
|
| Rate for Payer: Cigna Commercial |
$10,748.71
|
| Rate for Payer: First Health Commercial |
$12,302.74
|
| Rate for Payer: Humana Commercial |
$11,007.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,619.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,557.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,885.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,396.22
|
| Rate for Payer: Ohio Health Group HMO |
$9,712.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,360.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,266.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,935.67
|
| Rate for Payer: PHCS Commercial |
$12,432.24
|
| Rate for Payer: United Healthcare All Payer |
$11,396.22
|
|
|
STENT WALLFLX BIL COVERED 8*60
|
Facility
|
OP
|
$12,950.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,885.07 |
| Max. Negotiated Rate |
$12,432.24 |
| Rate for Payer: Aetna Commercial |
$9,971.69
|
| Rate for Payer: Anthem Medicaid |
$4,453.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,101.19
|
| Rate for Payer: Cash Price |
$6,475.12
|
| Rate for Payer: Cigna Commercial |
$10,748.71
|
| Rate for Payer: First Health Commercial |
$12,302.74
|
| Rate for Payer: Humana Commercial |
$11,007.71
|
| Rate for Payer: Humana KY Medicaid |
$4,453.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,498.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,619.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,557.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,885.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,542.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,396.22
|
| Rate for Payer: Ohio Health Group HMO |
$9,712.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,360.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,266.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,935.67
|
| Rate for Payer: PHCS Commercial |
$12,432.24
|
| Rate for Payer: United Healthcare All Payer |
$11,396.22
|
|
|
STENT WALLFLX ESOPH PC 23*10.5
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
STENT WALLFLX ESOPH PC 23*10.5
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
STENT WALLGRAFT 10*20 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 10*20 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 10*30 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 10*30 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 10*70 COVERED
|
Facility
|
OP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem Medicaid |
$4,043.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Humana KY Medicaid |
$4,043.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,084.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
STENT WALLGRAFT 10*70 COVERED
|
Facility
|
IP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
STENT WALLGRAFT 12*30 COVERED
|
Facility
|
IP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
STENT WALLGRAFT 12*30 COVERED
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
