|
VISI-PRO STENT 6*27*135
|
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*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*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 6*37*135
|
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 6*37*135
|
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 6*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*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 6*57*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*57*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 7*17*135
|
Facility
|
OP
|
$6,795.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.56 |
| Max. Negotiated Rate |
$6,523.39 |
| Rate for Payer: Aetna Commercial |
$5,232.30
|
| Rate for Payer: Anthem Medicaid |
$2,336.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.26
|
| Rate for Payer: Cash Price |
$3,397.60
|
| Rate for Payer: Cigna Commercial |
$5,640.02
|
| Rate for Payer: First Health Commercial |
$6,455.44
|
| Rate for Payer: Humana Commercial |
$5,775.92
|
| Rate for Payer: Humana KY Medicaid |
$2,336.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.69
|
| Rate for Payer: PHCS Commercial |
$6,523.39
|
| Rate for Payer: United Healthcare All Payer |
$5,979.78
|
|
|
VISI-PRO STENT 7*17*135
|
Facility
|
IP
|
$6,795.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.56 |
| Max. Negotiated Rate |
$6,523.39 |
| Rate for Payer: Aetna Commercial |
$5,232.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.26
|
| Rate for Payer: Cash Price |
$3,397.60
|
| Rate for Payer: Cigna Commercial |
$5,640.02
|
| Rate for Payer: First Health Commercial |
$6,455.44
|
| Rate for Payer: Humana Commercial |
$5,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.69
|
| Rate for Payer: PHCS Commercial |
$6,523.39
|
| Rate for Payer: United Healthcare All Payer |
$5,979.78
|
|
|
VISI-PRO STENT 7*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 7*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 7*27*135
|
Facility
|
OP
|
$6,795.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.56 |
| Max. Negotiated Rate |
$6,523.39 |
| Rate for Payer: Aetna Commercial |
$5,232.30
|
| Rate for Payer: Anthem Medicaid |
$2,336.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.26
|
| Rate for Payer: Cash Price |
$3,397.60
|
| Rate for Payer: Cigna Commercial |
$5,640.02
|
| Rate for Payer: First Health Commercial |
$6,455.44
|
| Rate for Payer: Humana Commercial |
$5,775.92
|
| Rate for Payer: Humana KY Medicaid |
$2,336.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.69
|
| Rate for Payer: PHCS Commercial |
$6,523.39
|
| Rate for Payer: United Healthcare All Payer |
$5,979.78
|
|
|
VISI-PRO STENT 7*27*135
|
Facility
|
IP
|
$6,795.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.56 |
| Max. Negotiated Rate |
$6,523.39 |
| Rate for Payer: Aetna Commercial |
$5,232.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.26
|
| Rate for Payer: Cash Price |
$3,397.60
|
| Rate for Payer: Cigna Commercial |
$5,640.02
|
| Rate for Payer: First Health Commercial |
$6,455.44
|
| Rate for Payer: Humana Commercial |
$5,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.69
|
| Rate for Payer: PHCS Commercial |
$6,523.39
|
| Rate for Payer: United Healthcare All Payer |
$5,979.78
|
|
|
VISI-PRO STENT 7*27*80
|
Facility
|
IP
|
$6,795.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.56 |
| Max. Negotiated Rate |
$6,523.39 |
| Rate for Payer: Aetna Commercial |
$5,232.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.26
|
| Rate for Payer: Cash Price |
$3,397.60
|
| Rate for Payer: Cigna Commercial |
$5,640.02
|
| Rate for Payer: First Health Commercial |
$6,455.44
|
| Rate for Payer: Humana Commercial |
$5,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.69
|
| Rate for Payer: PHCS Commercial |
$6,523.39
|
| Rate for Payer: United Healthcare All Payer |
$5,979.78
|
|
|
VISI-PRO STENT 7*27*80
|
Facility
|
OP
|
$6,795.20
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.56 |
| Max. Negotiated Rate |
$6,523.39 |
| Rate for Payer: Aetna Commercial |
$5,232.30
|
| Rate for Payer: Anthem Medicaid |
$2,336.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.26
|
| Rate for Payer: Cash Price |
$3,397.60
|
| Rate for Payer: Cigna Commercial |
$5,640.02
|
| Rate for Payer: First Health Commercial |
$6,455.44
|
| Rate for Payer: Humana Commercial |
$5,775.92
|
| Rate for Payer: Humana KY Medicaid |
$2,336.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,014.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,979.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,911.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,688.69
|
| Rate for Payer: PHCS Commercial |
$6,523.39
|
| Rate for Payer: United Healthcare All Payer |
$5,979.78
|
|
|
VISI-PRO STENT 7*37*135
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
VISI-PRO STENT 7*37*135
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
VISI-PRO STENT 7*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 7*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 7*57*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 7*57*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 8*17*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 8*17*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
|
|
