|
RX VISION STENT 2.75*12
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RX VISION STENT 2.75*12
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RX VISION STENT 2.75*15
|
Facility
|
IP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 2.75*15
|
Facility
|
OP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem Medicaid |
$1,406.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Humana KY Medicaid |
$1,406.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 2.75*18
|
Facility
|
IP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 2.75*18
|
Facility
|
OP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem Medicaid |
$1,406.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Humana KY Medicaid |
$1,406.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 2.75*23
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RX VISION STENT 2.75*23
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RX VISION STENT 2.75*28
|
Facility
|
IP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 2.75*28
|
Facility
|
OP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem Medicaid |
$1,406.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Humana KY Medicaid |
$1,406.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 2.75*8
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
RX VISION STENT 2.75*8
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
RX VISION STENT 3*12
|
Facility
|
IP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 3*12
|
Facility
|
OP
|
$4,090.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.70 |
| Max. Negotiated Rate |
$3,926.40 |
| Rate for Payer: Aetna Commercial |
$3,149.30
|
| Rate for Payer: Anthem Medicaid |
$1,406.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.20
|
| Rate for Payer: Cash Price |
$2,045.00
|
| Rate for Payer: Cigna Commercial |
$3,394.70
|
| Rate for Payer: First Health Commercial |
$3,885.50
|
| Rate for Payer: Humana Commercial |
$3,476.50
|
| Rate for Payer: Humana KY Medicaid |
$1,406.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,267.90
|
| Rate for Payer: PHCS Commercial |
$3,926.40
|
| Rate for Payer: United Healthcare All Payer |
$3,599.20
|
|
|
RX VISION STENT 3*15
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*15
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*18
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*18
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*23
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*23
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*28
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3*28
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
RX VISION STENT 3.5*12
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RX VISION STENT 3.5*12
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
RX VISION STENT 3.5*15
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
