|
VIABAHN VBX 6*59*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*79*135 STENT
|
Facility
|
OP
|
$18,315.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,381.03 |
| Max. Negotiated Rate |
$17,582.98 |
| Rate for Payer: Aetna Commercial |
$14,103.01
|
| Rate for Payer: Anthem Medicaid |
$6,298.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,286.17
|
| Rate for Payer: Cash Price |
$9,157.80
|
| Rate for Payer: Cigna Commercial |
$15,201.95
|
| Rate for Payer: First Health Commercial |
$17,399.82
|
| Rate for Payer: Humana Commercial |
$15,568.26
|
| Rate for Payer: Humana KY Medicaid |
$6,298.73
|
| Rate for Payer: Kentucky WC Medicaid |
$6,362.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,018.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,516.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,494.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,425.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,117.73
|
| Rate for Payer: Ohio Health Group HMO |
$13,736.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,663.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,381.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,677.84
|
| Rate for Payer: PHCS Commercial |
$17,582.98
|
| Rate for Payer: United Healthcare All Payer |
$16,117.73
|
|
|
VIABAHN VBX 6*79*135 STENT
|
Facility
|
IP
|
$18,315.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,381.03 |
| Max. Negotiated Rate |
$17,582.98 |
| Rate for Payer: Aetna Commercial |
$14,103.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,286.17
|
| Rate for Payer: Cash Price |
$9,157.80
|
| Rate for Payer: Cigna Commercial |
$15,201.95
|
| Rate for Payer: First Health Commercial |
$17,399.82
|
| Rate for Payer: Humana Commercial |
$15,568.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,018.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,516.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,494.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,117.73
|
| Rate for Payer: Ohio Health Group HMO |
$13,736.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,663.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,381.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,677.84
|
| Rate for Payer: PHCS Commercial |
$17,582.98
|
| Rate for Payer: United Healthcare All Payer |
$16,117.73
|
|
|
VIABAHN VBX 7*29*80 STENT
|
Facility
|
OP
|
$16,508.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.09 |
| Max. Negotiated Rate |
$15,848.06 |
| Rate for Payer: Aetna Commercial |
$12,711.47
|
| Rate for Payer: Anthem Medicaid |
$5,677.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,876.55
|
| Rate for Payer: Cash Price |
$8,254.20
|
| Rate for Payer: Cigna Commercial |
$13,701.97
|
| Rate for Payer: First Health Commercial |
$15,682.98
|
| Rate for Payer: Humana Commercial |
$14,032.14
|
| Rate for Payer: Humana KY Medicaid |
$5,677.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5,735.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,536.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,183.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,952.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,791.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,527.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,381.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,301.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,117.60
|
| Rate for Payer: PHCS Commercial |
$15,848.06
|
| Rate for Payer: United Healthcare All Payer |
$14,527.39
|
|
|
VIABAHN VBX 7*29*80 STENT
|
Facility
|
IP
|
$16,508.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.09 |
| Max. Negotiated Rate |
$15,848.06 |
| Rate for Payer: Aetna Commercial |
$12,711.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,876.55
|
| Rate for Payer: Cash Price |
$8,254.20
|
| Rate for Payer: Cigna Commercial |
$13,701.97
|
| Rate for Payer: First Health Commercial |
$15,682.98
|
| Rate for Payer: Humana Commercial |
$14,032.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,536.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,183.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,952.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,527.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,381.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,301.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,117.60
|
| Rate for Payer: PHCS Commercial |
$15,848.06
|
| Rate for Payer: United Healthcare All Payer |
$14,527.39
|
|
|
VIABAHN VBX 7*39*80 STENT
|
Facility
|
IP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
VIABAHN VBX 7*39*80 STENT
|
Facility
|
OP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem Medicaid |
$5,474.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Humana KY Medicaid |
$5,474.20
|
| Rate for Payer: Kentucky WC Medicaid |
$5,529.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,584.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
VIABAHN VBX 7*59*80 STENT
|
Facility
|
OP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem Medicaid |
$5,474.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Humana KY Medicaid |
$5,474.20
|
| Rate for Payer: Kentucky WC Medicaid |
$5,529.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,584.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
VIABAHN VBX 7*59*80 STENT
|
Facility
|
IP
|
$15,918.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.34 |
| Max. Negotiated Rate |
$15,281.28 |
| Rate for Payer: Aetna Commercial |
$12,256.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,416.04
|
| Rate for Payer: Cash Price |
$7,959.00
|
| Rate for Payer: Cigna Commercial |
$13,211.94
|
| Rate for Payer: First Health Commercial |
$15,122.10
|
| Rate for Payer: Humana Commercial |
$13,530.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,747.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,775.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,938.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,183.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,069.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,934.58
|
| Rate for Payer: PHCS Commercial |
$15,281.28
|
| Rate for Payer: United Healthcare All Payer |
$14,007.84
|
|
|
VIABAHN VBX 8*29*80 STENT
|
Facility
|
OP
|
$20,206.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,626.86 |
| Max. Negotiated Rate |
$19,398.38 |
| Rate for Payer: Aetna Commercial |
$15,559.12
|
| Rate for Payer: Anthem Medicaid |
$6,949.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,761.19
|
| Rate for Payer: Cash Price |
$10,103.33
|
| Rate for Payer: Cigna Commercial |
$16,771.52
|
| Rate for Payer: First Health Commercial |
$19,196.32
|
| Rate for Payer: Humana Commercial |
$17,175.65
|
| Rate for Payer: Humana KY Medicaid |
$6,949.07
|
| Rate for Payer: Kentucky WC Medicaid |
$7,019.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,569.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,912.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,062.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,088.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,781.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,154.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,626.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,264.06
|
| Rate for Payer: PHCS Commercial |
$19,398.38
|
| Rate for Payer: United Healthcare All Payer |
$17,781.85
|
|
|
VIABAHN VBX 8*29*80 STENT
|
Facility
|
IP
|
$20,206.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,626.86 |
| Max. Negotiated Rate |
$19,398.38 |
| Rate for Payer: Aetna Commercial |
$15,559.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,761.19
|
| Rate for Payer: Cash Price |
$10,103.33
|
| Rate for Payer: Cigna Commercial |
$16,771.52
|
| Rate for Payer: First Health Commercial |
$19,196.32
|
| Rate for Payer: Humana Commercial |
$17,175.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,569.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,912.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,062.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,781.85
|
| Rate for Payer: Ohio Health Group HMO |
$15,154.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,626.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,264.06
|
| Rate for Payer: PHCS Commercial |
$19,398.38
|
| Rate for Payer: United Healthcare All Payer |
$17,781.85
|
|
|
VIABAHN VBX 8*39*80
|
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 8*39*80
|
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 8*59*80
|
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 8*59*80
|
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
|
|
|
VIANCE CATH
|
Facility
|
OP
|
$9,351.75
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.73 |
| Max. Negotiated Rate |
$8,977.68 |
| Rate for Payer: Aetna Commercial |
$7,200.85
|
| Rate for Payer: Anthem Medicaid |
$3,216.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.36
|
| Rate for Payer: Cash Price |
$4,675.88
|
| Rate for Payer: Cigna Commercial |
$7,761.95
|
| Rate for Payer: First Health Commercial |
$8,884.16
|
| Rate for Payer: Humana Commercial |
$7,948.99
|
| Rate for Payer: Humana KY Medicaid |
$3,216.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,668.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,229.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,870.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,899.04
|
| Rate for Payer: PHCS Commercial |
$8,977.68
|
| Rate for Payer: United Healthcare All Payer |
$8,229.54
|
|
|
VIANCE CATH
|
Facility
|
IP
|
$9,351.75
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.73 |
| Max. Negotiated Rate |
$8,977.68 |
| Rate for Payer: Aetna Commercial |
$7,200.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.36
|
| Rate for Payer: Cash Price |
$4,675.88
|
| Rate for Payer: Cigna Commercial |
$7,761.95
|
| Rate for Payer: First Health Commercial |
$8,884.16
|
| Rate for Payer: Humana Commercial |
$7,948.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,668.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,229.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,870.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,899.04
|
| Rate for Payer: PHCS Commercial |
$8,977.68
|
| Rate for Payer: United Healthcare All Payer |
$8,229.54
|
|
|
VIATORR 6*2
|
Facility
|
OP
|
$22,152.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,879.77 |
| Max. Negotiated Rate |
$21,266.02 |
| Rate for Payer: Aetna Commercial |
$17,057.12
|
| Rate for Payer: Anthem Medicaid |
$7,618.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,278.64
|
| Rate for Payer: Cash Price |
$11,076.05
|
| Rate for Payer: Cigna Commercial |
$18,386.24
|
| Rate for Payer: First Health Commercial |
$21,044.50
|
| Rate for Payer: Humana Commercial |
$18,829.28
|
| Rate for Payer: Humana KY Medicaid |
$7,618.11
|
| Rate for Payer: Kentucky WC Medicaid |
$7,695.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,164.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,348.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,645.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,770.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,493.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,614.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,879.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.15
|
| Rate for Payer: PHCS Commercial |
$21,266.02
|
| Rate for Payer: United Healthcare All Payer |
$19,493.85
|
|
|
VIATORR 6*2
|
Facility
|
IP
|
$22,152.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,879.77 |
| Max. Negotiated Rate |
$21,266.02 |
| Rate for Payer: Aetna Commercial |
$17,057.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,278.64
|
| Rate for Payer: Cash Price |
$11,076.05
|
| Rate for Payer: Cigna Commercial |
$18,386.24
|
| Rate for Payer: First Health Commercial |
$21,044.50
|
| Rate for Payer: Humana Commercial |
$18,829.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,164.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,348.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,645.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,493.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,614.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,879.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.15
|
| Rate for Payer: PHCS Commercial |
$21,266.02
|
| Rate for Payer: United Healthcare All Payer |
$19,493.85
|
|
|
VIATORR 7*2
|
Facility
|
IP
|
$22,845.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,969.93 |
| Max. Negotiated Rate |
$21,931.78 |
| Rate for Payer: Aetna Commercial |
$17,591.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,819.57
|
| Rate for Payer: Cash Price |
$11,422.80
|
| Rate for Payer: Cigna Commercial |
$18,961.85
|
| Rate for Payer: First Health Commercial |
$21,703.32
|
| Rate for Payer: Humana Commercial |
$19,418.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,733.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,860.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,853.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,104.13
|
| Rate for Payer: Ohio Health Group HMO |
$17,134.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,569.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,969.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,082.14
|
| Rate for Payer: PHCS Commercial |
$21,931.78
|
| Rate for Payer: United Healthcare All Payer |
$20,104.13
|
|
|
VIATORR 7*2
|
Facility
|
OP
|
$22,845.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,969.93 |
| Max. Negotiated Rate |
$21,931.78 |
| Rate for Payer: Aetna Commercial |
$17,591.11
|
| Rate for Payer: Anthem Medicaid |
$7,856.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,819.57
|
| Rate for Payer: Cash Price |
$11,422.80
|
| Rate for Payer: Cigna Commercial |
$18,961.85
|
| Rate for Payer: First Health Commercial |
$21,703.32
|
| Rate for Payer: Humana Commercial |
$19,418.76
|
| Rate for Payer: Humana KY Medicaid |
$7,856.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,936.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,733.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,860.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,853.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,014.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,104.13
|
| Rate for Payer: Ohio Health Group HMO |
$17,134.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,569.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,969.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,082.14
|
| Rate for Payer: PHCS Commercial |
$21,931.78
|
| Rate for Payer: United Healthcare All Payer |
$20,104.13
|
|
|
VIATORR 8*2
|
Facility
|
OP
|
$22,152.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,879.77 |
| Max. Negotiated Rate |
$21,266.02 |
| Rate for Payer: Aetna Commercial |
$17,057.12
|
| Rate for Payer: Anthem Medicaid |
$7,618.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,278.64
|
| Rate for Payer: Cash Price |
$11,076.05
|
| Rate for Payer: Cigna Commercial |
$18,386.24
|
| Rate for Payer: First Health Commercial |
$21,044.50
|
| Rate for Payer: Humana Commercial |
$18,829.28
|
| Rate for Payer: Humana KY Medicaid |
$7,618.11
|
| Rate for Payer: Kentucky WC Medicaid |
$7,695.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,164.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,348.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,645.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,770.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,493.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,614.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,879.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.15
|
| Rate for Payer: PHCS Commercial |
$21,266.02
|
| Rate for Payer: United Healthcare All Payer |
$19,493.85
|
|
|
VIATORR 8*2
|
Facility
|
IP
|
$22,152.10
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,879.77 |
| Max. Negotiated Rate |
$21,266.02 |
| Rate for Payer: Aetna Commercial |
$17,057.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,278.64
|
| Rate for Payer: Cash Price |
$11,076.05
|
| Rate for Payer: Cigna Commercial |
$18,386.24
|
| Rate for Payer: First Health Commercial |
$21,044.50
|
| Rate for Payer: Humana Commercial |
$18,829.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,164.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,348.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,645.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,493.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,614.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,879.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.15
|
| Rate for Payer: PHCS Commercial |
$21,266.02
|
| Rate for Payer: United Healthcare All Payer |
$19,493.85
|
|
|
VIBATIV 10 MG( 750MG/50ML)
|
Facility
|
IP
|
$1,579.55
|
|
|
Service Code
|
HCPCS J3095
|
| Hospital Charge Code |
25003873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.34 |
| Max. Negotiated Rate |
$1,516.37 |
| Rate for Payer: Aetna Commercial |
$1,216.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.05
|
| Rate for Payer: Cash Price |
$789.78
|
| Rate for Payer: Cigna Commercial |
$1,311.03
|
| Rate for Payer: First Health Commercial |
$1,500.57
|
| Rate for Payer: Humana Commercial |
$1,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,184.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.66
|
| Rate for Payer: PHCS Commercial |
$1,516.37
|
| Rate for Payer: United Healthcare All Payer |
$1,390.00
|
|
|
VIBATIV 10 MG( 750MG/50ML)
|
Facility
|
OP
|
$1,579.55
|
|
|
Service Code
|
HCPCS J3095
|
| Hospital Charge Code |
25003873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$1,516.37 |
| Rate for Payer: Aetna Commercial |
$1,216.25
|
| Rate for Payer: Anthem Medicaid |
$543.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.51
|
| Rate for Payer: Cash Price |
$789.78
|
| Rate for Payer: Cash Price |
$789.78
|
| Rate for Payer: Cigna Commercial |
$1,311.03
|
| Rate for Payer: First Health Commercial |
$1,500.57
|
| Rate for Payer: Humana Commercial |
$1,342.62
|
| Rate for Payer: Humana KY Medicaid |
$543.21
|
| Rate for Payer: Humana Medicare Advantage |
$7.05
|
| Rate for Payer: Kentucky WC Medicaid |
$548.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,184.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.66
|
| Rate for Payer: PHCS Commercial |
$1,516.37
|
| Rate for Payer: United Healthcare All Payer |
$1,390.00
|
|
