|
VFEND I.V. 10MG (200MG VIAL)
|
Facility
|
OP
|
$329.30
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
25002431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$316.13 |
| Rate for Payer: Aetna Commercial |
$253.56
|
| Rate for Payer: Anthem Medicaid |
$113.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.85
|
| Rate for Payer: Cash Price |
$164.65
|
| Rate for Payer: Cigna Commercial |
$273.32
|
| Rate for Payer: First Health Commercial |
$312.84
|
| Rate for Payer: Humana Commercial |
$279.90
|
| Rate for Payer: Humana KY Medicaid |
$113.25
|
| Rate for Payer: Kentucky WC Medicaid |
$114.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.78
|
| Rate for Payer: Ohio Health Group HMO |
$246.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.08
|
| Rate for Payer: PHCS Commercial |
$316.13
|
| Rate for Payer: United Healthcare All Payer |
$289.78
|
|
|
VFEND(VORICONAZOLE)200MG TAB
|
Facility
|
OP
|
$24.50
|
|
|
Service Code
|
NDC 68462057330
|
| Hospital Charge Code |
25001665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Anthem Medicaid |
$8.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.11
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cigna Commercial |
$20.34
|
| Rate for Payer: First Health Commercial |
$23.28
|
| Rate for Payer: Humana Commercial |
$20.82
|
| Rate for Payer: Humana KY Medicaid |
$8.43
|
| Rate for Payer: Kentucky WC Medicaid |
$8.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.56
|
| Rate for Payer: Ohio Health Group HMO |
$18.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.60
|
| Rate for Payer: PHCS Commercial |
$23.52
|
| Rate for Payer: United Healthcare All Payer |
$21.56
|
|
|
VFEND(VORICONAZOLE)200MG TAB
|
Facility
|
IP
|
$24.50
|
|
|
Service Code
|
NDC 68462057330
|
| Hospital Charge Code |
25001665
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.11
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cigna Commercial |
$20.34
|
| Rate for Payer: First Health Commercial |
$23.28
|
| Rate for Payer: Humana Commercial |
$20.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.56
|
| Rate for Payer: Ohio Health Group HMO |
$18.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.60
|
| Rate for Payer: PHCS Commercial |
$23.52
|
| Rate for Payer: United Healthcare All Payer |
$21.56
|
|
|
VFEND (VORICONAZOLE) 50MG TAB
|
Facility
|
OP
|
$9.49
|
|
|
Service Code
|
NDC 49317030
|
| Hospital Charge Code |
25001664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Humana KY Medicaid |
$3.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.35
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.11
|
| Rate for Payer: United Healthcare All Payer |
$8.35
|
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Anthem Medicaid |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.40
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
|
|
VFEND (VORICONAZOLE) 50MG TAB
|
Facility
|
IP
|
$9.49
|
|
|
Service Code
|
NDC 49317030
|
| Hospital Charge Code |
25001664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$7.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.40
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.35
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.11
|
| Rate for Payer: United Healthcare All Payer |
$8.35
|
|
|
VIABAHN 13*25
|
Facility
|
OP
|
$15,630.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.90 |
| Max. Negotiated Rate |
$15,004.80 |
| Rate for Payer: Aetna Commercial |
$12,035.10
|
| Rate for Payer: Anthem Medicaid |
$5,375.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.40
|
| Rate for Payer: Cash Price |
$7,815.00
|
| Rate for Payer: Cigna Commercial |
$12,972.90
|
| Rate for Payer: First Health Commercial |
$14,848.50
|
| Rate for Payer: Humana Commercial |
$13,285.50
|
| Rate for Payer: Humana KY Medicaid |
$5,375.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5,429.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,689.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,483.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,031.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.30
|
| Rate for Payer: PHCS Commercial |
$15,004.80
|
| Rate for Payer: United Healthcare All Payer |
$13,754.40
|
|
|
VIABAHN 13*25
|
Facility
|
IP
|
$15,630.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.90 |
| Max. Negotiated Rate |
$15,004.80 |
| Rate for Payer: Aetna Commercial |
$12,035.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.40
|
| Rate for Payer: Cash Price |
$7,815.00
|
| Rate for Payer: Cigna Commercial |
$12,972.90
|
| Rate for Payer: First Health Commercial |
$14,848.50
|
| Rate for Payer: Humana Commercial |
$13,285.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,689.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,031.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.30
|
| Rate for Payer: PHCS Commercial |
$15,004.80
|
| Rate for Payer: United Healthcare All Payer |
$13,754.40
|
|
|
VIABAHN 5*10*120
|
Facility
|
IP
|
$20,250.45
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.56 |
| Max. Negotiated Rate |
$19,440.43 |
| Rate for Payer: Aetna Commercial |
$15,592.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,795.35
|
| Rate for Payer: Cash Price |
$10,125.23
|
| Rate for Payer: Cigna Commercial |
$16,807.87
|
| Rate for Payer: First Health Commercial |
$19,237.93
|
| Rate for Payer: Humana Commercial |
$17,212.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,605.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,944.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,075.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,187.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,632.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,277.64
|
| Rate for Payer: PHCS Commercial |
$19,440.43
|
| Rate for Payer: United Healthcare All Payer |
$17,820.40
|
|
|
VIABAHN 5*10*120
|
Facility
|
OP
|
$20,250.45
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.56 |
| Max. Negotiated Rate |
$19,440.43 |
| Rate for Payer: Aetna Commercial |
$15,592.85
|
| Rate for Payer: Anthem Medicaid |
$6,964.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,795.35
|
| Rate for Payer: Cash Price |
$10,125.23
|
| Rate for Payer: Cigna Commercial |
$16,807.87
|
| Rate for Payer: First Health Commercial |
$19,237.93
|
| Rate for Payer: Humana Commercial |
$17,212.88
|
| Rate for Payer: Humana KY Medicaid |
$6,964.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,035.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,605.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,944.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,075.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,103.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,187.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,632.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,277.64
|
| Rate for Payer: PHCS Commercial |
$19,440.43
|
| Rate for Payer: United Healthcare All Payer |
$17,820.40
|
|
|
VIABAHN 5*15*120
|
Facility
|
IP
|
$16,321.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.76 |
| Max. Negotiated Rate |
$15,668.35 |
| Rate for Payer: Aetna Commercial |
$12,567.32
|
| Rate for Payer: Aetna Commercial |
$16,315.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,730.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,527.03
|
| Rate for Payer: Cash Price |
$8,160.60
|
| Rate for Payer: Cash Price |
$10,594.25
|
| Rate for Payer: Cigna Commercial |
$13,546.60
|
| Rate for Payer: Cigna Commercial |
$17,586.46
|
| Rate for Payer: First Health Commercial |
$20,129.08
|
| Rate for Payer: First Health Commercial |
$15,505.14
|
| Rate for Payer: Humana Commercial |
$18,010.22
|
| Rate for Payer: Humana Commercial |
$13,873.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,383.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,374.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,045.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,637.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,356.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,896.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,362.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,645.88
|
| Rate for Payer: Ohio Health Group HMO |
$12,240.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,891.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,237.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,121.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,754.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,568.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,059.57
|
| Rate for Payer: PHCS Commercial |
$15,668.35
|
| Rate for Payer: PHCS Commercial |
$20,340.96
|
| Rate for Payer: United Healthcare All Payer |
$14,362.66
|
| Rate for Payer: United Healthcare All Payer |
$18,645.88
|
|
|
VIABAHN 5*15*120
|
Facility
|
OP
|
$16,321.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.76 |
| Max. Negotiated Rate |
$15,668.35 |
| Rate for Payer: Aetna Commercial |
$12,567.32
|
| Rate for Payer: Aetna Commercial |
$16,315.14
|
| Rate for Payer: Anthem Medicaid |
$5,612.86
|
| Rate for Payer: Anthem Medicaid |
$7,286.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,730.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,527.03
|
| Rate for Payer: Cash Price |
$8,160.60
|
| Rate for Payer: Cash Price |
$10,594.25
|
| Rate for Payer: Cigna Commercial |
$17,586.46
|
| Rate for Payer: Cigna Commercial |
$13,546.60
|
| Rate for Payer: First Health Commercial |
$20,129.08
|
| Rate for Payer: First Health Commercial |
$15,505.14
|
| Rate for Payer: Humana Commercial |
$13,873.02
|
| Rate for Payer: Humana Commercial |
$18,010.22
|
| Rate for Payer: Humana KY Medicaid |
$5,612.86
|
| Rate for Payer: Humana KY Medicaid |
$7,286.73
|
| Rate for Payer: Kentucky WC Medicaid |
$7,360.88
|
| Rate for Payer: Kentucky WC Medicaid |
$5,669.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,383.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,374.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,637.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,045.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,356.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,896.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,725.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,432.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,362.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,645.88
|
| Rate for Payer: Ohio Health Group HMO |
$12,240.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,891.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,237.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,121.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,754.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,059.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,568.44
|
| Rate for Payer: PHCS Commercial |
$20,340.96
|
| Rate for Payer: PHCS Commercial |
$15,668.35
|
| Rate for Payer: United Healthcare All Payer |
$18,645.88
|
| Rate for Payer: United Healthcare All Payer |
$14,362.66
|
|
|
VIABAHN 5*2.5*120
|
Facility
|
IP
|
$17,725.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.28 |
| Max. Negotiated Rate |
$17,016.19 |
| Rate for Payer: Aetna Commercial |
$13,648.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,825.66
|
| Rate for Payer: Cash Price |
$8,862.60
|
| Rate for Payer: Cigna Commercial |
$14,711.92
|
| Rate for Payer: First Health Commercial |
$16,838.94
|
| Rate for Payer: Humana Commercial |
$15,066.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,534.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,081.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,317.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,598.18
|
| Rate for Payer: Ohio Health Group HMO |
$13,293.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,304.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,494.81
|
| Rate for Payer: PHCS Commercial |
$17,016.19
|
| Rate for Payer: United Healthcare All Payer |
$15,598.18
|
|
|
VIABAHN 5*2.5*120
|
Facility
|
OP
|
$17,725.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.28 |
| Max. Negotiated Rate |
$17,016.19 |
| Rate for Payer: Aetna Commercial |
$13,648.40
|
| Rate for Payer: Anthem Medicaid |
$6,095.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,825.66
|
| Rate for Payer: Cash Price |
$8,862.60
|
| Rate for Payer: Cigna Commercial |
$14,711.92
|
| Rate for Payer: First Health Commercial |
$16,838.94
|
| Rate for Payer: Humana Commercial |
$15,066.42
|
| Rate for Payer: Humana KY Medicaid |
$6,095.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6,157.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,534.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,081.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,317.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,218.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,598.18
|
| Rate for Payer: Ohio Health Group HMO |
$13,293.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,304.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,494.81
|
| Rate for Payer: PHCS Commercial |
$17,016.19
|
| Rate for Payer: United Healthcare All Payer |
$15,598.18
|
|
|
VIABAHN 5*5*120
|
Facility
|
IP
|
$17,725.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.28 |
| Max. Negotiated Rate |
$17,016.19 |
| Rate for Payer: Aetna Commercial |
$13,648.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,825.66
|
| Rate for Payer: Cash Price |
$8,862.60
|
| Rate for Payer: Cigna Commercial |
$14,711.92
|
| Rate for Payer: First Health Commercial |
$16,838.94
|
| Rate for Payer: Humana Commercial |
$15,066.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,534.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,081.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,317.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,598.18
|
| Rate for Payer: Ohio Health Group HMO |
$13,293.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,304.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,494.81
|
| Rate for Payer: PHCS Commercial |
$17,016.19
|
| Rate for Payer: United Healthcare All Payer |
$15,598.18
|
|
|
VIABAHN 5*5*120
|
Facility
|
OP
|
$17,725.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.28 |
| Max. Negotiated Rate |
$17,016.19 |
| Rate for Payer: Aetna Commercial |
$13,648.40
|
| Rate for Payer: Anthem Medicaid |
$6,095.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,825.66
|
| Rate for Payer: Cash Price |
$8,862.60
|
| Rate for Payer: Cigna Commercial |
$14,711.92
|
| Rate for Payer: First Health Commercial |
$16,838.94
|
| Rate for Payer: Humana Commercial |
$15,066.42
|
| Rate for Payer: Humana KY Medicaid |
$6,095.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6,157.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,534.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,081.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,317.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,218.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,598.18
|
| Rate for Payer: Ohio Health Group HMO |
$13,293.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,304.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,494.81
|
| Rate for Payer: PHCS Commercial |
$17,016.19
|
| Rate for Payer: United Healthcare All Payer |
$15,598.18
|
|
|
VIABAHN 6*10*120
|
Facility
|
IP
|
$13,906.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.90 |
| Max. Negotiated Rate |
$13,350.62 |
| Rate for Payer: Aetna Commercial |
$10,708.31
|
| Rate for Payer: Aetna Commercial |
$15,592.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,847.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,795.35
|
| Rate for Payer: Cash Price |
$6,953.45
|
| Rate for Payer: Cash Price |
$10,125.23
|
| Rate for Payer: Cigna Commercial |
$11,542.73
|
| Rate for Payer: Cigna Commercial |
$16,807.87
|
| Rate for Payer: First Health Commercial |
$19,237.93
|
| Rate for Payer: First Health Commercial |
$13,211.56
|
| Rate for Payer: Humana Commercial |
$17,212.88
|
| Rate for Payer: Humana Commercial |
$11,820.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,403.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,605.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,263.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,944.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,075.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,172.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,238.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,430.18
|
| Rate for Payer: Ohio Health Group HMO |
$15,187.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,781.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,807.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,632.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,277.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,311.14
|
| Rate for Payer: PHCS Commercial |
$13,350.62
|
| Rate for Payer: PHCS Commercial |
$19,440.43
|
| Rate for Payer: United Healthcare All Payer |
$12,238.07
|
| Rate for Payer: United Healthcare All Payer |
$17,820.40
|
|
|
VIABAHN 6*10*120
|
Facility
|
OP
|
$13,906.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.90 |
| Max. Negotiated Rate |
$13,350.62 |
| Rate for Payer: Aetna Commercial |
$10,708.31
|
| Rate for Payer: Aetna Commercial |
$15,592.85
|
| Rate for Payer: Anthem Medicaid |
$4,782.58
|
| Rate for Payer: Anthem Medicaid |
$6,964.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,847.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,795.35
|
| Rate for Payer: Cash Price |
$6,953.45
|
| Rate for Payer: Cash Price |
$10,125.23
|
| Rate for Payer: Cigna Commercial |
$16,807.87
|
| Rate for Payer: Cigna Commercial |
$11,542.73
|
| Rate for Payer: First Health Commercial |
$19,237.93
|
| Rate for Payer: First Health Commercial |
$13,211.56
|
| Rate for Payer: Humana Commercial |
$11,820.86
|
| Rate for Payer: Humana Commercial |
$17,212.88
|
| Rate for Payer: Humana KY Medicaid |
$4,782.58
|
| Rate for Payer: Humana KY Medicaid |
$6,964.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,035.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,831.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,403.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,605.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,944.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,263.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,075.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,172.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,878.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,103.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,238.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,430.18
|
| Rate for Payer: Ohio Health Group HMO |
$15,187.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,781.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,807.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,632.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,311.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,277.64
|
| Rate for Payer: PHCS Commercial |
$19,440.43
|
| Rate for Payer: PHCS Commercial |
$13,350.62
|
| Rate for Payer: United Healthcare All Payer |
$17,820.40
|
| Rate for Payer: United Healthcare All Payer |
$12,238.07
|
|
|
VIABAHN 6*15*120
|
Facility
|
OP
|
$16,321.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.76 |
| Max. Negotiated Rate |
$15,668.35 |
| Rate for Payer: Aetna Commercial |
$12,567.32
|
| Rate for Payer: Aetna Commercial |
$16,953.13
|
| Rate for Payer: Anthem Medicaid |
$5,612.86
|
| Rate for Payer: Anthem Medicaid |
$7,571.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,730.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,173.30
|
| Rate for Payer: Cash Price |
$8,160.60
|
| Rate for Payer: Cash Price |
$11,008.52
|
| Rate for Payer: Cigna Commercial |
$18,274.15
|
| Rate for Payer: Cigna Commercial |
$13,546.60
|
| Rate for Payer: First Health Commercial |
$20,916.20
|
| Rate for Payer: First Health Commercial |
$15,505.14
|
| Rate for Payer: Humana Commercial |
$13,873.02
|
| Rate for Payer: Humana Commercial |
$18,714.49
|
| Rate for Payer: Humana KY Medicaid |
$5,612.86
|
| Rate for Payer: Humana KY Medicaid |
$7,571.66
|
| Rate for Payer: Kentucky WC Medicaid |
$7,648.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,669.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,383.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,053.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,248.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,045.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,605.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,896.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,725.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,723.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,362.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,375.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,240.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,512.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,403.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,121.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,059.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,825.29
|
| Rate for Payer: PHCS Commercial |
$21,136.37
|
| Rate for Payer: PHCS Commercial |
$15,668.35
|
| Rate for Payer: United Healthcare All Payer |
$19,375.00
|
| Rate for Payer: United Healthcare All Payer |
$14,362.66
|
|
|
VIABAHN 6*15*120
|
Facility
|
IP
|
$16,321.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.76 |
| Max. Negotiated Rate |
$15,668.35 |
| Rate for Payer: Aetna Commercial |
$12,567.32
|
| Rate for Payer: Aetna Commercial |
$16,953.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,730.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,173.30
|
| Rate for Payer: Cash Price |
$8,160.60
|
| Rate for Payer: Cash Price |
$11,008.52
|
| Rate for Payer: Cigna Commercial |
$13,546.60
|
| Rate for Payer: Cigna Commercial |
$18,274.15
|
| Rate for Payer: First Health Commercial |
$20,916.20
|
| Rate for Payer: First Health Commercial |
$15,505.14
|
| Rate for Payer: Humana Commercial |
$18,714.49
|
| Rate for Payer: Humana Commercial |
$13,873.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,383.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,053.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,045.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,248.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,605.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,896.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,362.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,375.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,240.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,512.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,403.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,121.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,825.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,059.57
|
| Rate for Payer: PHCS Commercial |
$15,668.35
|
| Rate for Payer: PHCS Commercial |
$21,136.37
|
| Rate for Payer: United Healthcare All Payer |
$14,362.66
|
| Rate for Payer: United Healthcare All Payer |
$19,375.00
|
|
|
VIABAHN 6*2.5*120
|
Facility
|
IP
|
$18,592.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.06 |
| Max. Negotiated Rate |
$17,849.09 |
| Rate for Payer: Aetna Commercial |
$14,316.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,502.38
|
| Rate for Payer: Cash Price |
$9,296.40
|
| Rate for Payer: Cigna Commercial |
$15,432.02
|
| Rate for Payer: First Health Commercial |
$17,663.16
|
| Rate for Payer: Humana Commercial |
$15,803.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,246.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,721.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,577.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,361.66
|
| Rate for Payer: Ohio Health Group HMO |
$13,944.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,718.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,763.77
|
| Rate for Payer: PHCS Commercial |
$17,849.09
|
| Rate for Payer: United Healthcare All Payer |
$16,361.66
|
|
|
VIABAHN 6*2.5*120
|
Facility
|
OP
|
$18,592.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.06 |
| Max. Negotiated Rate |
$17,849.09 |
| Rate for Payer: Aetna Commercial |
$14,316.46
|
| Rate for Payer: Anthem Medicaid |
$6,394.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,502.38
|
| Rate for Payer: Cash Price |
$9,296.40
|
| Rate for Payer: Cigna Commercial |
$15,432.02
|
| Rate for Payer: First Health Commercial |
$17,663.16
|
| Rate for Payer: Humana Commercial |
$15,803.88
|
| Rate for Payer: Humana KY Medicaid |
$6,394.06
|
| Rate for Payer: Kentucky WC Medicaid |
$6,459.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,246.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,721.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,577.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,522.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,361.66
|
| Rate for Payer: Ohio Health Group HMO |
$13,944.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,718.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,763.77
|
| Rate for Payer: PHCS Commercial |
$17,849.09
|
| Rate for Payer: United Healthcare All Payer |
$16,361.66
|
|
|
VIABAHN 6*5*120
|
Facility
|
OP
|
$13,662.35
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,776.11 |
| Max. Negotiated Rate |
$13,115.86 |
| Rate for Payer: Aetna Commercial |
$10,520.01
|
| Rate for Payer: Aetna Commercial |
$14,316.46
|
| Rate for Payer: Anthem Medicaid |
$4,698.48
|
| Rate for Payer: Anthem Medicaid |
$6,394.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,656.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,502.38
|
| Rate for Payer: Cash Price |
$6,831.18
|
| Rate for Payer: Cash Price |
$9,296.40
|
| Rate for Payer: Cigna Commercial |
$15,432.02
|
| Rate for Payer: Cigna Commercial |
$11,339.75
|
| Rate for Payer: First Health Commercial |
$17,663.16
|
| Rate for Payer: First Health Commercial |
$12,979.23
|
| Rate for Payer: Humana Commercial |
$11,613.00
|
| Rate for Payer: Humana Commercial |
$15,803.88
|
| Rate for Payer: Humana KY Medicaid |
$4,698.48
|
| Rate for Payer: Humana KY Medicaid |
$6,394.06
|
| Rate for Payer: Kentucky WC Medicaid |
$6,459.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,746.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,203.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,246.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,721.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,082.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,577.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,098.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,792.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,522.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,022.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,361.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,246.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,944.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,732.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,718.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,776.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,235.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,763.77
|
| Rate for Payer: PHCS Commercial |
$17,849.09
|
| Rate for Payer: PHCS Commercial |
$13,115.86
|
| Rate for Payer: United Healthcare All Payer |
$16,361.66
|
| Rate for Payer: United Healthcare All Payer |
$12,022.87
|
|
|
VIABAHN 6*5*120
|
Facility
|
IP
|
$13,662.35
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,776.11 |
| Max. Negotiated Rate |
$13,115.86 |
| Rate for Payer: Aetna Commercial |
$10,520.01
|
| Rate for Payer: Aetna Commercial |
$14,316.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,656.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,502.38
|
| Rate for Payer: Cash Price |
$6,831.18
|
| Rate for Payer: Cash Price |
$9,296.40
|
| Rate for Payer: Cigna Commercial |
$11,339.75
|
| Rate for Payer: Cigna Commercial |
$15,432.02
|
| Rate for Payer: First Health Commercial |
$17,663.16
|
| Rate for Payer: First Health Commercial |
$12,979.23
|
| Rate for Payer: Humana Commercial |
$15,803.88
|
| Rate for Payer: Humana Commercial |
$11,613.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,203.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,246.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,082.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,721.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,577.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,098.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,022.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,361.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,246.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,944.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,732.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,718.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,776.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,763.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,235.33
|
| Rate for Payer: PHCS Commercial |
$13,115.86
|
| Rate for Payer: PHCS Commercial |
$17,849.09
|
| Rate for Payer: United Healthcare All Payer |
$12,022.87
|
| Rate for Payer: United Healthcare All Payer |
$16,361.66
|
|
|
VIABAHN 7*10*120
|
Facility
|
IP
|
$20,250.45
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.56 |
| Max. Negotiated Rate |
$19,440.43 |
| Rate for Payer: Aetna Commercial |
$15,592.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,795.35
|
| Rate for Payer: Cash Price |
$10,125.23
|
| Rate for Payer: Cigna Commercial |
$16,807.87
|
| Rate for Payer: First Health Commercial |
$19,237.93
|
| Rate for Payer: Humana Commercial |
$17,212.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,605.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,944.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,075.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,187.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,632.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,277.64
|
| Rate for Payer: PHCS Commercial |
$19,440.43
|
| Rate for Payer: United Healthcare All Payer |
$17,820.40
|
|
|
VIABAHN 7*10*120
|
Facility
|
OP
|
$20,250.45
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.56 |
| Max. Negotiated Rate |
$19,440.43 |
| Rate for Payer: Aetna Commercial |
$15,592.85
|
| Rate for Payer: Anthem Medicaid |
$6,964.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,795.35
|
| Rate for Payer: Cash Price |
$10,125.23
|
| Rate for Payer: Cigna Commercial |
$16,807.87
|
| Rate for Payer: First Health Commercial |
$19,237.93
|
| Rate for Payer: Humana Commercial |
$17,212.88
|
| Rate for Payer: Humana KY Medicaid |
$6,964.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,035.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,605.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,944.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,075.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,103.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,187.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,632.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,277.64
|
| Rate for Payer: PHCS Commercial |
$19,440.43
|
| Rate for Payer: United Healthcare All Payer |
$17,820.40
|
|
