|
VIABAHN 7*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 7*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 7*5*120
|
Facility
|
IP
|
$18,132.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,357.16 |
| Max. Negotiated Rate |
$17,406.72 |
| Rate for Payer: Aetna Commercial |
$13,961.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,142.96
|
| Rate for Payer: Cash Price |
$9,066.00
|
| Rate for Payer: Cigna Commercial |
$15,049.56
|
| Rate for Payer: First Health Commercial |
$17,225.40
|
| Rate for Payer: Humana Commercial |
$15,412.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,868.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,381.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,439.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,956.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,357.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,620.92
|
| Rate for Payer: PHCS Commercial |
$17,406.72
|
| Rate for Payer: United Healthcare All Payer |
$15,956.16
|
|
|
VIABAHN 7*5*120
|
Facility
|
OP
|
$18,132.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,357.16 |
| Max. Negotiated Rate |
$17,406.72 |
| Rate for Payer: Aetna Commercial |
$13,961.64
|
| Rate for Payer: Anthem Medicaid |
$6,235.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,142.96
|
| Rate for Payer: Cash Price |
$9,066.00
|
| Rate for Payer: Cigna Commercial |
$15,049.56
|
| Rate for Payer: First Health Commercial |
$17,225.40
|
| Rate for Payer: Humana Commercial |
$15,412.20
|
| Rate for Payer: Humana KY Medicaid |
$6,235.59
|
| Rate for Payer: Kentucky WC Medicaid |
$6,299.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,868.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,381.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,439.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,360.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,956.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,357.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,620.92
|
| Rate for Payer: PHCS Commercial |
$17,406.72
|
| Rate for Payer: United Healthcare All Payer |
$15,956.16
|
|
|
VIABAHN 8*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 8*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 8*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 8*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 8*5*120
|
Facility
|
IP
|
$18,132.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,357.16 |
| Max. Negotiated Rate |
$17,406.72 |
| Rate for Payer: Aetna Commercial |
$13,961.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,142.96
|
| Rate for Payer: Cash Price |
$9,066.00
|
| Rate for Payer: Cigna Commercial |
$15,049.56
|
| Rate for Payer: First Health Commercial |
$17,225.40
|
| Rate for Payer: Humana Commercial |
$15,412.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,868.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,381.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,439.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,956.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,357.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,620.92
|
| Rate for Payer: PHCS Commercial |
$17,406.72
|
| Rate for Payer: United Healthcare All Payer |
$15,956.16
|
|
|
VIABAHN 8*5*120
|
Facility
|
OP
|
$18,132.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,357.16 |
| Max. Negotiated Rate |
$17,406.72 |
| Rate for Payer: Aetna Commercial |
$13,961.64
|
| Rate for Payer: Anthem Medicaid |
$6,235.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,142.96
|
| Rate for Payer: Cash Price |
$9,066.00
|
| Rate for Payer: Cigna Commercial |
$15,049.56
|
| Rate for Payer: First Health Commercial |
$17,225.40
|
| Rate for Payer: Humana Commercial |
$15,412.20
|
| Rate for Payer: Humana KY Medicaid |
$6,235.59
|
| Rate for Payer: Kentucky WC Medicaid |
$6,299.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,868.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,381.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,439.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,360.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,956.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,357.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,620.92
|
| Rate for Payer: PHCS Commercial |
$17,406.72
|
| Rate for Payer: United Healthcare All Payer |
$15,956.16
|
|
|
VIABAHN BALLOON 8*59MM 8FR 135
|
Facility
|
IP
|
$17,581.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,285.56 |
| Max. Negotiated Rate |
$16,877.95 |
| Rate for Payer: Aetna Commercial |
$13,537.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,713.34
|
| Rate for Payer: Cash Price |
$8,790.60
|
| Rate for Payer: Cigna Commercial |
$14,592.40
|
| Rate for Payer: First Health Commercial |
$16,702.14
|
| Rate for Payer: Humana Commercial |
$14,944.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,416.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,974.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,274.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,471.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,185.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,516.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,285.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,450.17
|
| Rate for Payer: PHCS Commercial |
$16,877.95
|
| Rate for Payer: United Healthcare All Payer |
$15,471.46
|
|
|
VIABAHN BALLOON 8*59MM 8FR 135
|
Facility
|
OP
|
$17,581.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,285.56 |
| Max. Negotiated Rate |
$16,877.95 |
| Rate for Payer: Aetna Commercial |
$13,537.52
|
| Rate for Payer: Anthem Medicaid |
$6,046.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,713.34
|
| Rate for Payer: Cash Price |
$8,790.60
|
| Rate for Payer: Cigna Commercial |
$14,592.40
|
| Rate for Payer: First Health Commercial |
$16,702.14
|
| Rate for Payer: Humana Commercial |
$14,944.02
|
| Rate for Payer: Humana KY Medicaid |
$6,046.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,107.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,416.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,974.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,274.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,167.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,471.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,185.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,516.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,285.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,450.17
|
| Rate for Payer: PHCS Commercial |
$16,877.95
|
| Rate for Payer: United Healthcare All Payer |
$15,471.46
|
|
|
VIABAHN VBX 11*39*135 STENT
|
Facility
|
IP
|
$18,049.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,346.40 |
| Max. Negotiated Rate |
$17,327.23 |
| Rate for Payer: Aetna Commercial |
$13,897.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,078.38
|
| Rate for Payer: Cash Price |
$9,024.60
|
| Rate for Payer: Cigna Commercial |
$14,980.84
|
| Rate for Payer: First Health Commercial |
$17,146.74
|
| Rate for Payer: Humana Commercial |
$15,341.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,800.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,320.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,414.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,883.30
|
| Rate for Payer: Ohio Health Group HMO |
$13,536.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,609.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,346.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.25
|
| Rate for Payer: PHCS Commercial |
$17,327.23
|
| Rate for Payer: United Healthcare All Payer |
$15,883.30
|
|
|
VIABAHN VBX 11*39*135 STENT
|
Facility
|
OP
|
$18,049.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,346.40 |
| Max. Negotiated Rate |
$17,327.23 |
| Rate for Payer: Aetna Commercial |
$13,897.88
|
| Rate for Payer: Anthem Medicaid |
$6,207.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,078.38
|
| Rate for Payer: Cash Price |
$9,024.60
|
| Rate for Payer: Cigna Commercial |
$14,980.84
|
| Rate for Payer: First Health Commercial |
$17,146.74
|
| Rate for Payer: Humana Commercial |
$15,341.82
|
| Rate for Payer: Humana KY Medicaid |
$6,207.12
|
| Rate for Payer: Kentucky WC Medicaid |
$6,270.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,800.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,320.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,414.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,331.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,883.30
|
| Rate for Payer: Ohio Health Group HMO |
$13,536.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,609.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,346.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.25
|
| Rate for Payer: PHCS Commercial |
$17,327.23
|
| Rate for Payer: United Healthcare All Payer |
$15,883.30
|
|
|
VIABAHN VBX 5*19*135 STENT
|
Facility
|
IP
|
$13,363.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$12,828.53 |
| Rate for Payer: Aetna Commercial |
$10,289.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,423.18
|
| Rate for Payer: Cash Price |
$6,681.52
|
| Rate for Payer: Cigna Commercial |
$11,091.33
|
| Rate for Payer: First Health Commercial |
$12,694.90
|
| Rate for Payer: Humana Commercial |
$11,358.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,957.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,861.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,759.48
|
| Rate for Payer: Ohio Health Group HMO |
$10,022.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.55
|
| Rate for Payer: PHCS Commercial |
$12,828.53
|
| Rate for Payer: United Healthcare All Payer |
$11,759.48
|
|
|
VIABAHN VBX 5*19*135 STENT
|
Facility
|
OP
|
$13,363.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$12,828.53 |
| Rate for Payer: Aetna Commercial |
$10,289.55
|
| Rate for Payer: Anthem Medicaid |
$4,595.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,423.18
|
| Rate for Payer: Cash Price |
$6,681.52
|
| Rate for Payer: Cigna Commercial |
$11,091.33
|
| Rate for Payer: First Health Commercial |
$12,694.90
|
| Rate for Payer: Humana Commercial |
$11,358.59
|
| Rate for Payer: Humana KY Medicaid |
$4,595.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,957.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,861.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,687.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,759.48
|
| Rate for Payer: Ohio Health Group HMO |
$10,022.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.55
|
| Rate for Payer: PHCS Commercial |
$12,828.53
|
| Rate for Payer: United Healthcare All Payer |
$11,759.48
|
|
|
VIABAHN VBX 6*15*135 STENT
|
Facility
|
IP
|
$13,363.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$12,828.53 |
| Rate for Payer: Aetna Commercial |
$10,289.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,423.18
|
| Rate for Payer: Cash Price |
$6,681.52
|
| Rate for Payer: Cigna Commercial |
$11,091.33
|
| Rate for Payer: First Health Commercial |
$12,694.90
|
| Rate for Payer: Humana Commercial |
$11,358.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,957.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,861.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,759.48
|
| Rate for Payer: Ohio Health Group HMO |
$10,022.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.55
|
| Rate for Payer: PHCS Commercial |
$12,828.53
|
| Rate for Payer: United Healthcare All Payer |
$11,759.48
|
|
|
VIABAHN VBX 6*15*135 STENT
|
Facility
|
OP
|
$13,363.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$12,828.53 |
| Rate for Payer: Aetna Commercial |
$10,289.55
|
| Rate for Payer: Anthem Medicaid |
$4,595.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,423.18
|
| Rate for Payer: Cash Price |
$6,681.52
|
| Rate for Payer: Cigna Commercial |
$11,091.33
|
| Rate for Payer: First Health Commercial |
$12,694.90
|
| Rate for Payer: Humana Commercial |
$11,358.59
|
| Rate for Payer: Humana KY Medicaid |
$4,595.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,957.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,861.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,687.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,759.48
|
| Rate for Payer: Ohio Health Group HMO |
$10,022.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.55
|
| Rate for Payer: PHCS Commercial |
$12,828.53
|
| Rate for Payer: United Healthcare All Payer |
$11,759.48
|
|
|
VIABAHN VBX 6*19*135 STENT
|
Facility
|
IP
|
$13,363.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$12,828.53 |
| Rate for Payer: Aetna Commercial |
$10,289.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,423.18
|
| Rate for Payer: Cash Price |
$6,681.52
|
| Rate for Payer: Cigna Commercial |
$11,091.33
|
| Rate for Payer: First Health Commercial |
$12,694.90
|
| Rate for Payer: Humana Commercial |
$11,358.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,957.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,861.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,759.48
|
| Rate for Payer: Ohio Health Group HMO |
$10,022.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.55
|
| Rate for Payer: PHCS Commercial |
$12,828.53
|
| Rate for Payer: United Healthcare All Payer |
$11,759.48
|
|
|
VIABAHN VBX 6*19*135 STENT
|
Facility
|
OP
|
$13,363.05
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.20 |
| Max. Negotiated Rate |
$12,828.53 |
| Rate for Payer: Aetna Commercial |
$10,289.55
|
| Rate for Payer: Anthem Medicaid |
$4,595.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,423.18
|
| Rate for Payer: Cash Price |
$6,681.52
|
| Rate for Payer: Cigna Commercial |
$11,091.33
|
| Rate for Payer: First Health Commercial |
$12,694.90
|
| Rate for Payer: Humana Commercial |
$11,358.59
|
| Rate for Payer: Humana KY Medicaid |
$4,595.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,642.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,957.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,861.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,687.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,759.48
|
| Rate for Payer: Ohio Health Group HMO |
$10,022.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.55
|
| Rate for Payer: PHCS Commercial |
$12,828.53
|
| Rate for Payer: United Healthcare All Payer |
$11,759.48
|
|
|
VIABAHN VBX 6*29*135 STENT
|
Facility
|
IP
|
$16,209.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.25 |
| Max. Negotiated Rate |
$15,561.22 |
| Rate for Payer: Aetna Commercial |
$12,481.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,643.49
|
| Rate for Payer: Cash Price |
$8,104.80
|
| Rate for Payer: Cigna Commercial |
$13,453.97
|
| Rate for Payer: First Health Commercial |
$15,399.12
|
| Rate for Payer: Humana Commercial |
$13,778.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,291.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,264.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,157.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.98
|
| Rate for Payer: PHCS Commercial |
$15,561.22
|
| Rate for Payer: United Healthcare All Payer |
$14,264.45
|
|
|
VIABAHN VBX 6*29*135 STENT
|
Facility
|
OP
|
$16,209.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.25 |
| Max. Negotiated Rate |
$15,561.22 |
| Rate for Payer: Aetna Commercial |
$12,481.39
|
| Rate for Payer: Anthem Medicaid |
$5,574.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,643.49
|
| Rate for Payer: Cash Price |
$8,104.80
|
| Rate for Payer: Cigna Commercial |
$13,453.97
|
| Rate for Payer: First Health Commercial |
$15,399.12
|
| Rate for Payer: Humana Commercial |
$13,778.16
|
| Rate for Payer: Humana KY Medicaid |
$5,574.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,291.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,686.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,264.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,157.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.98
|
| Rate for Payer: PHCS Commercial |
$15,561.22
|
| Rate for Payer: United Healthcare All Payer |
$14,264.45
|
|
|
VIABAHN VBX 6*39*135 STENT
|
Facility
|
OP
|
$16,209.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.25 |
| Max. Negotiated Rate |
$15,561.22 |
| Rate for Payer: Aetna Commercial |
$12,481.39
|
| Rate for Payer: Anthem Medicaid |
$5,574.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,643.49
|
| Rate for Payer: Cash Price |
$8,104.80
|
| Rate for Payer: Cigna Commercial |
$13,453.97
|
| Rate for Payer: First Health Commercial |
$15,399.12
|
| Rate for Payer: Humana Commercial |
$13,778.16
|
| Rate for Payer: Humana KY Medicaid |
$5,574.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,291.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,686.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,264.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,157.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.98
|
| Rate for Payer: PHCS Commercial |
$15,561.22
|
| Rate for Payer: United Healthcare All Payer |
$14,264.45
|
|
|
VIABAHN VBX 6*39*135 STENT
|
Facility
|
IP
|
$16,209.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.25 |
| Max. Negotiated Rate |
$15,561.22 |
| Rate for Payer: Aetna Commercial |
$12,481.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,643.49
|
| Rate for Payer: Cash Price |
$8,104.80
|
| Rate for Payer: Cigna Commercial |
$13,453.97
|
| Rate for Payer: First Health Commercial |
$15,399.12
|
| Rate for Payer: Humana Commercial |
$13,778.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,291.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,264.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,157.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.98
|
| Rate for Payer: PHCS Commercial |
$15,561.22
|
| Rate for Payer: United Healthcare All Payer |
$14,264.45
|
|
|
VIABAHN VBX 6*59*135 STENT
|
Facility
|
IP
|
$16,209.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.25 |
| Max. Negotiated Rate |
$15,561.22 |
| Rate for Payer: Aetna Commercial |
$12,481.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,643.49
|
| Rate for Payer: Cash Price |
$8,104.80
|
| Rate for Payer: Cigna Commercial |
$13,453.97
|
| Rate for Payer: First Health Commercial |
$15,399.12
|
| Rate for Payer: Humana Commercial |
$13,778.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,291.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,264.45
|
| Rate for Payer: Ohio Health Group HMO |
$12,157.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,024.98
|
| Rate for Payer: PHCS Commercial |
$15,561.22
|
| Rate for Payer: United Healthcare All Payer |
$14,264.45
|
|
