|
RX VISION STENT 3*12
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
RX VISION STENT 3*12
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
RX VISION STENT 3*15
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*15
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*18
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*18
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*23
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*23
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*28
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3*28
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3.5*12
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
RX VISION STENT 3.5*12
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
RX VISION STENT 3.5*15
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3.5*15
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
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
|
|
|
RX VISION STENT 3.5*18
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
RX VISION STENT 3.5*18
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
RX VISION STENT 3.5*23
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
RX VISION STENT 3.5*23
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
RX VISION STENT 3.5*28
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
RX VISION STENT 3.5*28
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
RX VISION STENT 3.5*8
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
RX VISION STENT 3.5*8
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
RX VISION STENT 3*8
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
RX VISION STENT 3*8
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
RX VISION STENT 4*12
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
