|
VISI-PRO STENT 7*37*135
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
VISI-PRO STENT 7*37*80
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 7*37*80
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 7*57*80
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 7*57*80
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 8*17*80
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 8*17*80
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 8*27*135
|
Facility
|
IP
|
$8,037.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$7,716.24 |
| Rate for Payer: Aetna Commercial |
$6,189.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,269.44
|
| Rate for Payer: Cash Price |
$4,018.88
|
| Rate for Payer: Cigna Commercial |
$6,671.33
|
| Rate for Payer: First Health Commercial |
$7,635.86
|
| Rate for Payer: Humana Commercial |
$6,832.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,073.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,028.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,607.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.70
|
| Rate for Payer: PHCS Commercial |
$7,716.24
|
| Rate for Payer: United Healthcare All Payer |
$7,073.22
|
|
|
VISI-PRO STENT 8*27*135
|
Facility
|
OP
|
$8,037.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$7,716.24 |
| Rate for Payer: Aetna Commercial |
$6,189.07
|
| Rate for Payer: Anthem Medicaid |
$2,764.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,269.44
|
| Rate for Payer: Cash Price |
$4,018.88
|
| Rate for Payer: Cigna Commercial |
$6,671.33
|
| Rate for Payer: First Health Commercial |
$7,635.86
|
| Rate for Payer: Humana Commercial |
$6,832.09
|
| Rate for Payer: Humana KY Medicaid |
$2,764.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,073.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,028.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,607.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.70
|
| Rate for Payer: PHCS Commercial |
$7,716.24
|
| Rate for Payer: United Healthcare All Payer |
$7,073.22
|
|
|
VISI-PRO STENT 8*27*80
|
Facility
|
IP
|
$8,037.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$7,716.24 |
| Rate for Payer: Aetna Commercial |
$6,189.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,269.44
|
| Rate for Payer: Cash Price |
$4,018.88
|
| Rate for Payer: Cigna Commercial |
$6,671.33
|
| Rate for Payer: First Health Commercial |
$7,635.86
|
| Rate for Payer: Humana Commercial |
$6,832.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,073.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,028.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,607.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.70
|
| Rate for Payer: PHCS Commercial |
$7,716.24
|
| Rate for Payer: United Healthcare All Payer |
$7,073.22
|
|
|
VISI-PRO STENT 8*27*80
|
Facility
|
OP
|
$8,037.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$7,716.24 |
| Rate for Payer: Aetna Commercial |
$6,189.07
|
| Rate for Payer: Anthem Medicaid |
$2,764.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,269.44
|
| Rate for Payer: Cash Price |
$4,018.88
|
| Rate for Payer: Cigna Commercial |
$6,671.33
|
| Rate for Payer: First Health Commercial |
$7,635.86
|
| Rate for Payer: Humana Commercial |
$6,832.09
|
| Rate for Payer: Humana KY Medicaid |
$2,764.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,792.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,590.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,931.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,411.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,819.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,073.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,028.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,607.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.70
|
| Rate for Payer: PHCS Commercial |
$7,716.24
|
| Rate for Payer: United Healthcare All Payer |
$7,073.22
|
|
|
VISI-PRO STENT 8*37*-135
|
Facility
|
IP
|
$5,227.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.58 |
| Max. Negotiated Rate |
$5,018.40 |
| Rate for Payer: Aetna Commercial |
$4,025.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Cash Price |
$2,613.75
|
| Rate for Payer: Cigna Commercial |
$4,338.82
|
| Rate for Payer: First Health Commercial |
$4,966.12
|
| Rate for Payer: Humana Commercial |
$4,443.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,286.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,857.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,568.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,600.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,920.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,045.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,620.52
|
| Rate for Payer: PHCS Commercial |
$5,018.40
|
| Rate for Payer: United Healthcare All Payer |
$4,600.20
|
|
|
VISI-PRO STENT 8*37*-135
|
Facility
|
OP
|
$5,227.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.58 |
| Max. Negotiated Rate |
$5,018.40 |
| Rate for Payer: Aetna Commercial |
$4,025.18
|
| Rate for Payer: Anthem Medicaid |
$1,797.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Cash Price |
$2,613.75
|
| Rate for Payer: Cigna Commercial |
$4,338.82
|
| Rate for Payer: First Health Commercial |
$4,966.12
|
| Rate for Payer: Humana Commercial |
$4,443.38
|
| Rate for Payer: Humana KY Medicaid |
$1,797.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,816.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,286.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,857.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,568.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,833.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,600.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,920.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,045.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,620.52
|
| Rate for Payer: PHCS Commercial |
$5,018.40
|
| Rate for Payer: United Healthcare All Payer |
$4,600.20
|
|
|
VISI-PRO STENT 8*37*80
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
VISI-PRO STENT 8*37*80
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
VISI-PRO STENT 8*57*80
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
VISI-PRO STENT 8*57*80
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
VISI-PRO STENT 9*27*80
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 9*27*80
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 9*37*80
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 9*37*80
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 9*57*80
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISI-PRO STENT 9*57*80
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
VISKEN (PINDOLOL) 5 M 5MG/1TAB
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 62559056001
|
| Hospital Charge Code |
25001680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
VISKEN (PINDOLOL) 5 M 5MG/1TAB
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 62559056001
|
| Hospital Charge Code |
25001680
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
