|
VISIONS PV .014P DIG IVUS CATH
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
VISIONS PV .014P DIG IVUS CATH
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
VISIONS PV .035 DIG. IVUS CATH
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
VISIONS PV .035 DIG. IVUS CATH
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
VISIPAQUE 270 1mL (150mL SDV)
|
Facility
|
IP
|
$716.54
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
25004284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.96 |
| Max. Negotiated Rate |
$687.88 |
| Rate for Payer: Aetna Commercial |
$551.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.90
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cigna Commercial |
$594.73
|
| Rate for Payer: First Health Commercial |
$680.71
|
| Rate for Payer: Humana Commercial |
$609.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$587.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$528.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$630.56
|
| Rate for Payer: Ohio Health Group HMO |
$537.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.41
|
| Rate for Payer: PHCS Commercial |
$687.88
|
| Rate for Payer: United Healthcare All Payer |
$630.56
|
|
|
VISIPAQUE 270 1mL (150mL SDV)
|
Facility
|
OP
|
$716.54
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
25004284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.96 |
| Max. Negotiated Rate |
$687.88 |
| Rate for Payer: Aetna Commercial |
$551.74
|
| Rate for Payer: Anthem Medicaid |
$246.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$558.90
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cigna Commercial |
$594.73
|
| Rate for Payer: First Health Commercial |
$680.71
|
| Rate for Payer: Humana Commercial |
$609.06
|
| Rate for Payer: Humana KY Medicaid |
$246.42
|
| Rate for Payer: Kentucky WC Medicaid |
$248.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$587.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$528.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$251.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$630.56
|
| Rate for Payer: Ohio Health Group HMO |
$537.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.41
|
| Rate for Payer: PHCS Commercial |
$687.88
|
| Rate for Payer: United Healthcare All Payer |
$630.56
|
|
|
VISIPAQUE 320 1mL (100mL SDV)
|
Facility
|
OP
|
$490.93
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25003578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$471.29 |
| Rate for Payer: Aetna Commercial |
$378.02
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Anthem Medicaid |
$168.83
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.83
|
| Rate for Payer: Cash Price |
$245.46
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: Cigna Commercial |
$407.47
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: First Health Commercial |
$466.38
|
| Rate for Payer: Humana Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$4.17
|
| Rate for Payer: Humana KY Medicaid |
$168.83
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$170.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.32
|
| Rate for Payer: Ohio Health Group HMO |
$368.20
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.39
|
| Rate for Payer: PHCS Commercial |
$4.71
|
| Rate for Payer: PHCS Commercial |
$471.29
|
| Rate for Payer: United Healthcare All Payer |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$432.02
|
|
|
VISIPAQUE 320 1mL (100mL SDV)
|
Facility
|
IP
|
$490.93
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25003578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$471.29 |
| Rate for Payer: Aetna Commercial |
$378.02
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.83
|
| Rate for Payer: Cash Price |
$245.46
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$407.47
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: First Health Commercial |
$466.38
|
| Rate for Payer: Humana Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$417.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.31
|
| 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 Benefit Exchange |
$147.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.32
|
| Rate for Payer: Ohio Health Group HMO |
$368.20
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.74
|
| Rate for Payer: PHCS Commercial |
$471.29
|
| Rate for Payer: PHCS Commercial |
$4.71
|
| Rate for Payer: United Healthcare All Payer |
$432.02
|
| Rate for Payer: United Healthcare All Payer |
$4.32
|
|
|
VISIPORT PLUS 5MM-12MM TROCAR
|
Facility
|
OP
|
$1,762.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.85 |
| Max. Negotiated Rate |
$1,692.33 |
| Rate for Payer: Aetna Commercial |
$1,357.39
|
| Rate for Payer: Anthem Medicaid |
$606.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.02
|
| Rate for Payer: Cash Price |
$881.42
|
| Rate for Payer: Cigna Commercial |
$1,463.16
|
| Rate for Payer: First Health Commercial |
$1,674.70
|
| Rate for Payer: Humana Commercial |
$1,498.41
|
| Rate for Payer: Humana KY Medicaid |
$606.24
|
| Rate for Payer: Kentucky WC Medicaid |
$612.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,300.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.36
|
| Rate for Payer: PHCS Commercial |
$1,692.33
|
| Rate for Payer: United Healthcare All Payer |
$1,551.30
|
|
|
VISIPORT PLUS 5MM-12MM TROCAR
|
Facility
|
IP
|
$1,762.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.85 |
| Max. Negotiated Rate |
$1,692.33 |
| Rate for Payer: Aetna Commercial |
$1,357.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.02
|
| Rate for Payer: Cash Price |
$881.42
|
| Rate for Payer: Cigna Commercial |
$1,463.16
|
| Rate for Payer: First Health Commercial |
$1,674.70
|
| Rate for Payer: Humana Commercial |
$1,498.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,300.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.36
|
| Rate for Payer: PHCS Commercial |
$1,692.33
|
| Rate for Payer: United Healthcare All Payer |
$1,551.30
|
|
|
VISI-PRO STENT 10*27*80
|
Facility
|
IP
|
$4,343.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna Commercial |
$3,344.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,388.12
|
| Rate for Payer: Cash Price |
$2,171.88
|
| Rate for Payer: Cigna Commercial |
$3,605.31
|
| Rate for Payer: First Health Commercial |
$4,126.56
|
| Rate for Payer: Humana Commercial |
$3,692.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,779.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.19
|
| Rate for Payer: PHCS Commercial |
$4,170.00
|
| Rate for Payer: United Healthcare All Payer |
$3,822.50
|
|
|
VISI-PRO STENT 10*27*80
|
Facility
|
OP
|
$4,343.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna Commercial |
$3,344.69
|
| Rate for Payer: Anthem Medicaid |
$1,493.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,388.12
|
| Rate for Payer: Cash Price |
$2,171.88
|
| Rate for Payer: Cigna Commercial |
$3,605.31
|
| Rate for Payer: First Health Commercial |
$4,126.56
|
| Rate for Payer: Humana Commercial |
$3,692.19
|
| Rate for Payer: Humana KY Medicaid |
$1,493.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,779.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.19
|
| Rate for Payer: PHCS Commercial |
$4,170.00
|
| Rate for Payer: United Healthcare All Payer |
$3,822.50
|
|
|
VISI-PRO STENT 10*37*80
|
Facility
|
IP
|
$5,243.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.12 |
| Max. Negotiated Rate |
$5,034.00 |
| Rate for Payer: Aetna Commercial |
$4,037.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,090.12
|
| Rate for Payer: Cash Price |
$2,621.88
|
| Rate for Payer: Cigna Commercial |
$4,352.31
|
| Rate for Payer: First Health Commercial |
$4,981.56
|
| Rate for Payer: Humana Commercial |
$4,457.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,299.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,869.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,573.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,614.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,932.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,562.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,618.19
|
| Rate for Payer: PHCS Commercial |
$5,034.00
|
| Rate for Payer: United Healthcare All Payer |
$4,614.50
|
|
|
VISI-PRO STENT 10*37*80
|
Facility
|
OP
|
$5,243.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.12 |
| Max. Negotiated Rate |
$5,034.00 |
| Rate for Payer: Aetna Commercial |
$4,037.69
|
| Rate for Payer: Anthem Medicaid |
$1,803.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,090.12
|
| Rate for Payer: Cash Price |
$2,621.88
|
| Rate for Payer: Cigna Commercial |
$4,352.31
|
| Rate for Payer: First Health Commercial |
$4,981.56
|
| Rate for Payer: Humana Commercial |
$4,457.19
|
| Rate for Payer: Humana KY Medicaid |
$1,803.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,821.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,299.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,869.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,573.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,839.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,614.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,932.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,562.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,618.19
|
| Rate for Payer: PHCS Commercial |
$5,034.00
|
| Rate for Payer: United Healthcare All Payer |
$4,614.50
|
|
|
VISI-PRO STENT 5*17*80
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 5*17*80
|
Facility
|
OP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem Medicaid |
$1,524.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Humana KY Medicaid |
$1,524.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 5*27*135
|
Facility
|
IP
|
$5,243.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.12 |
| Max. Negotiated Rate |
$5,034.00 |
| Rate for Payer: Aetna Commercial |
$4,037.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,090.12
|
| Rate for Payer: Cash Price |
$2,621.88
|
| Rate for Payer: Cigna Commercial |
$4,352.31
|
| Rate for Payer: First Health Commercial |
$4,981.56
|
| Rate for Payer: Humana Commercial |
$4,457.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,299.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,869.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,573.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,614.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,932.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,562.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,618.19
|
| Rate for Payer: PHCS Commercial |
$5,034.00
|
| Rate for Payer: United Healthcare All Payer |
$4,614.50
|
|
|
VISI-PRO STENT 5*27*135
|
Facility
|
OP
|
$5,243.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.12 |
| Max. Negotiated Rate |
$5,034.00 |
| Rate for Payer: Aetna Commercial |
$4,037.69
|
| Rate for Payer: Anthem Medicaid |
$1,803.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,090.12
|
| Rate for Payer: Cash Price |
$2,621.88
|
| Rate for Payer: Cigna Commercial |
$4,352.31
|
| Rate for Payer: First Health Commercial |
$4,981.56
|
| Rate for Payer: Humana Commercial |
$4,457.19
|
| Rate for Payer: Humana KY Medicaid |
$1,803.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,821.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,299.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,869.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,573.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,839.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,614.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,932.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,562.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,618.19
|
| Rate for Payer: PHCS Commercial |
$5,034.00
|
| Rate for Payer: United Healthcare All Payer |
$4,614.50
|
|
|
VISI-PRO STENT 5*27*80
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 5*27*80
|
Facility
|
OP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem Medicaid |
$1,524.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Humana KY Medicaid |
$1,524.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 5*37*80
|
Facility
|
OP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem Medicaid |
$1,524.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Humana KY Medicaid |
$1,524.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 5*37*80
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 6*17*80
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 6*17*80
|
Facility
|
OP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem Medicaid |
$1,524.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Humana KY Medicaid |
$1,524.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
VISI-PRO STENT 6*27*135
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
