|
VIABAHN 13*25
|
Facility
|
OP
|
$16,147.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,844.25 |
| Max. Negotiated Rate |
$15,501.60 |
| Rate for Payer: Aetna Commercial |
$12,433.58
|
| Rate for Payer: Anthem Medicaid |
$5,553.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,595.05
|
| Rate for Payer: Cash Price |
$8,073.75
|
| Rate for Payer: Cigna Commercial |
$13,402.42
|
| Rate for Payer: First Health Commercial |
$15,340.12
|
| Rate for Payer: Humana Commercial |
$13,725.38
|
| Rate for Payer: Humana KY Medicaid |
$5,553.13
|
| Rate for Payer: Kentucky WC Medicaid |
$5,609.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,240.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,916.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,844.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,664.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,209.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,110.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,918.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,048.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,141.77
|
| Rate for Payer: PHCS Commercial |
$15,501.60
|
| Rate for Payer: United Healthcare All Payer |
$14,209.80
|
|
|
VIABAHN 13*25
|
Facility
|
IP
|
$16,147.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,844.25 |
| Max. Negotiated Rate |
$15,501.60 |
| Rate for Payer: Aetna Commercial |
$12,433.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,595.05
|
| Rate for Payer: Cash Price |
$8,073.75
|
| Rate for Payer: Cigna Commercial |
$13,402.42
|
| Rate for Payer: First Health Commercial |
$15,340.12
|
| Rate for Payer: Humana Commercial |
$13,725.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,240.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,916.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,844.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,209.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,110.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,918.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,048.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,141.77
|
| Rate for Payer: PHCS Commercial |
$15,501.60
|
| Rate for Payer: United Healthcare All Payer |
$14,209.80
|
|
|
VIABAHN 5*10*120
|
Facility
|
OP
|
$21,398.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,419.62 |
| Max. Negotiated Rate |
$20,542.80 |
| Rate for Payer: Aetna Commercial |
$16,477.04
|
| Rate for Payer: Anthem Medicaid |
$7,359.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,691.03
|
| Rate for Payer: Cash Price |
$10,699.38
|
| Rate for Payer: Cigna Commercial |
$17,760.96
|
| Rate for Payer: First Health Commercial |
$20,328.81
|
| Rate for Payer: Humana Commercial |
$18,188.94
|
| Rate for Payer: Humana KY Medicaid |
$7,359.03
|
| Rate for Payer: Kentucky WC Medicaid |
$7,433.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,546.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,792.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,419.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,506.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,830.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,049.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,616.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,765.14
|
| Rate for Payer: PHCS Commercial |
$20,542.80
|
| Rate for Payer: United Healthcare All Payer |
$18,830.90
|
|
|
VIABAHN 5*10*120
|
Facility
|
IP
|
$21,398.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,419.62 |
| Max. Negotiated Rate |
$20,542.80 |
| Rate for Payer: Aetna Commercial |
$16,477.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,691.03
|
| Rate for Payer: Cash Price |
$10,699.38
|
| Rate for Payer: Cigna Commercial |
$17,760.96
|
| Rate for Payer: First Health Commercial |
$20,328.81
|
| Rate for Payer: Humana Commercial |
$18,188.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,546.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,792.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,419.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,830.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,049.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,616.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,765.14
|
| Rate for Payer: PHCS Commercial |
$20,542.80
|
| Rate for Payer: United Healthcare All Payer |
$18,830.90
|
|
|
VIABAHN 5*15*120
|
Facility
|
OP
|
$16,857.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,057.37 |
| Max. Negotiated Rate |
$16,183.58 |
| Rate for Payer: Aetna Commercial |
$12,980.58
|
| Rate for Payer: Aetna Commercial |
$16,814.88
|
| Rate for Payer: Anthem Medicaid |
$5,797.43
|
| Rate for Payer: Anthem Medicaid |
$7,509.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,033.25
|
| Rate for Payer: Cash Price |
$8,428.95
|
| Rate for Payer: Cash Price |
$10,918.75
|
| Rate for Payer: Cigna Commercial |
$18,125.12
|
| Rate for Payer: Cigna Commercial |
$13,992.06
|
| Rate for Payer: First Health Commercial |
$20,745.62
|
| Rate for Payer: First Health Commercial |
$16,015.00
|
| Rate for Payer: Humana Commercial |
$14,329.22
|
| Rate for Payer: Humana Commercial |
$18,561.88
|
| Rate for Payer: Humana KY Medicaid |
$5,797.43
|
| Rate for Payer: Humana KY Medicaid |
$7,509.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,586.35
|
| Rate for Payer: Kentucky WC Medicaid |
$5,856.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,823.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,906.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,116.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,441.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,551.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,057.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,913.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,660.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,834.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,217.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,643.42
|
| Rate for Payer: Ohio Health Group HMO |
$16,378.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,486.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,666.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,998.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,631.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,067.88
|
| Rate for Payer: PHCS Commercial |
$20,964.00
|
| Rate for Payer: PHCS Commercial |
$16,183.58
|
| Rate for Payer: United Healthcare All Payer |
$19,217.00
|
| Rate for Payer: United Healthcare All Payer |
$14,834.95
|
|
|
VIABAHN 5*15*120
|
Facility
|
IP
|
$16,857.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,057.37 |
| Max. Negotiated Rate |
$16,183.58 |
| Rate for Payer: Aetna Commercial |
$12,980.58
|
| Rate for Payer: Aetna Commercial |
$16,814.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,033.25
|
| Rate for Payer: Cash Price |
$8,428.95
|
| Rate for Payer: Cash Price |
$10,918.75
|
| Rate for Payer: Cigna Commercial |
$13,992.06
|
| Rate for Payer: Cigna Commercial |
$18,125.12
|
| Rate for Payer: First Health Commercial |
$20,745.62
|
| Rate for Payer: First Health Commercial |
$16,015.00
|
| Rate for Payer: Humana Commercial |
$18,561.88
|
| Rate for Payer: Humana Commercial |
$14,329.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,823.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,906.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,441.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,116.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,551.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,057.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,834.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,217.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,643.42
|
| Rate for Payer: Ohio Health Group HMO |
$16,378.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,486.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,666.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,998.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,067.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,631.95
|
| Rate for Payer: PHCS Commercial |
$16,183.58
|
| Rate for Payer: PHCS Commercial |
$20,964.00
|
| Rate for Payer: United Healthcare All Payer |
$14,834.95
|
| Rate for Payer: United Healthcare All Payer |
$19,217.00
|
|
|
VIABAHN 5*2.5*120
|
Facility
|
OP
|
$18,300.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.27 |
| Max. Negotiated Rate |
$17,568.86 |
| Rate for Payer: Aetna Commercial |
$14,091.69
|
| Rate for Payer: Anthem Medicaid |
$6,293.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,274.70
|
| Rate for Payer: Cash Price |
$9,150.45
|
| Rate for Payer: Cigna Commercial |
$15,189.75
|
| Rate for Payer: First Health Commercial |
$17,385.85
|
| Rate for Payer: Humana Commercial |
$15,555.76
|
| Rate for Payer: Humana KY Medicaid |
$6,293.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6,357.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,006.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,506.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,490.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,419.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,104.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,725.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,640.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,627.62
|
| Rate for Payer: PHCS Commercial |
$17,568.86
|
| Rate for Payer: United Healthcare All Payer |
$16,104.79
|
|
|
VIABAHN 5*2.5*120
|
Facility
|
IP
|
$18,300.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.27 |
| Max. Negotiated Rate |
$17,568.86 |
| Rate for Payer: Aetna Commercial |
$14,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,274.70
|
| Rate for Payer: Cash Price |
$9,150.45
|
| Rate for Payer: Cigna Commercial |
$15,189.75
|
| Rate for Payer: First Health Commercial |
$17,385.85
|
| Rate for Payer: Humana Commercial |
$15,555.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,006.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,506.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,490.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,104.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,725.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,640.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,627.62
|
| Rate for Payer: PHCS Commercial |
$17,568.86
|
| Rate for Payer: United Healthcare All Payer |
$16,104.79
|
|
|
VIABAHN 5*5*120
|
Facility
|
IP
|
$18,300.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.27 |
| Max. Negotiated Rate |
$17,568.86 |
| Rate for Payer: Aetna Commercial |
$14,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,274.70
|
| Rate for Payer: Cash Price |
$9,150.45
|
| Rate for Payer: Cigna Commercial |
$15,189.75
|
| Rate for Payer: First Health Commercial |
$17,385.85
|
| Rate for Payer: Humana Commercial |
$15,555.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,006.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,506.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,490.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,104.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,725.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,640.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,627.62
|
| Rate for Payer: PHCS Commercial |
$17,568.86
|
| Rate for Payer: United Healthcare All Payer |
$16,104.79
|
|
|
VIABAHN 5*5*120
|
Facility
|
OP
|
$18,300.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.27 |
| Max. Negotiated Rate |
$17,568.86 |
| Rate for Payer: Aetna Commercial |
$14,091.69
|
| Rate for Payer: Anthem Medicaid |
$6,293.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,274.70
|
| Rate for Payer: Cash Price |
$9,150.45
|
| Rate for Payer: Cigna Commercial |
$15,189.75
|
| Rate for Payer: First Health Commercial |
$17,385.85
|
| Rate for Payer: Humana Commercial |
$15,555.76
|
| Rate for Payer: Humana KY Medicaid |
$6,293.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6,357.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,006.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,506.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,490.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,419.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,104.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,725.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,640.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,627.62
|
| Rate for Payer: PHCS Commercial |
$17,568.86
|
| Rate for Payer: United Healthcare All Payer |
$16,104.79
|
|
|
VIABAHN 6*10*120
|
Facility
|
IP
|
$14,165.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,249.51 |
| Max. Negotiated Rate |
$13,598.42 |
| Rate for Payer: Aetna Commercial |
$10,907.07
|
| Rate for Payer: Aetna Commercial |
$16,728.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,048.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,945.50
|
| Rate for Payer: Cash Price |
$7,082.51
|
| Rate for Payer: Cash Price |
$10,862.50
|
| Rate for Payer: Cigna Commercial |
$11,756.97
|
| Rate for Payer: Cigna Commercial |
$18,031.75
|
| Rate for Payer: First Health Commercial |
$20,638.75
|
| Rate for Payer: First Health Commercial |
$13,456.77
|
| Rate for Payer: Humana Commercial |
$18,466.25
|
| Rate for Payer: Humana Commercial |
$12,040.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,615.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,814.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,453.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,033.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,517.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,249.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,465.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,118.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,332.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,323.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,900.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,990.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,773.86
|
| Rate for Payer: PHCS Commercial |
$13,598.42
|
| Rate for Payer: PHCS Commercial |
$20,856.00
|
| Rate for Payer: United Healthcare All Payer |
$12,465.22
|
| Rate for Payer: United Healthcare All Payer |
$19,118.00
|
|
|
VIABAHN 6*10*120
|
Facility
|
OP
|
$14,165.02
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,249.51 |
| Max. Negotiated Rate |
$13,598.42 |
| Rate for Payer: Aetna Commercial |
$10,907.07
|
| Rate for Payer: Aetna Commercial |
$16,728.25
|
| Rate for Payer: Anthem Medicaid |
$4,871.35
|
| Rate for Payer: Anthem Medicaid |
$7,471.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,048.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,945.50
|
| Rate for Payer: Cash Price |
$7,082.51
|
| Rate for Payer: Cash Price |
$10,862.50
|
| Rate for Payer: Cigna Commercial |
$18,031.75
|
| Rate for Payer: Cigna Commercial |
$11,756.97
|
| Rate for Payer: First Health Commercial |
$20,638.75
|
| Rate for Payer: First Health Commercial |
$13,456.77
|
| Rate for Payer: Humana Commercial |
$12,040.27
|
| Rate for Payer: Humana Commercial |
$18,466.25
|
| Rate for Payer: Humana KY Medicaid |
$4,871.35
|
| Rate for Payer: Humana KY Medicaid |
$7,471.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,547.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,920.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,615.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,814.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,033.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,453.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,517.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,249.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,969.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,621.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,465.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,118.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,623.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,332.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,323.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,900.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,773.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,990.25
|
| Rate for Payer: PHCS Commercial |
$20,856.00
|
| Rate for Payer: PHCS Commercial |
$13,598.42
|
| Rate for Payer: United Healthcare All Payer |
$19,118.00
|
| Rate for Payer: United Healthcare All Payer |
$12,465.22
|
|
|
VIABAHN 6*15*120
|
Facility
|
OP
|
$16,857.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,057.37 |
| Max. Negotiated Rate |
$16,183.58 |
| Rate for Payer: Aetna Commercial |
$12,980.58
|
| Rate for Payer: Aetna Commercial |
$18,200.88
|
| Rate for Payer: Anthem Medicaid |
$5,797.43
|
| Rate for Payer: Anthem Medicaid |
$8,128.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,437.25
|
| Rate for Payer: Cash Price |
$8,428.95
|
| Rate for Payer: Cash Price |
$11,818.75
|
| Rate for Payer: Cigna Commercial |
$19,619.12
|
| Rate for Payer: Cigna Commercial |
$13,992.06
|
| Rate for Payer: First Health Commercial |
$22,455.62
|
| Rate for Payer: First Health Commercial |
$16,015.00
|
| Rate for Payer: Humana Commercial |
$14,329.22
|
| Rate for Payer: Humana Commercial |
$20,091.88
|
| Rate for Payer: Humana KY Medicaid |
$5,797.43
|
| Rate for Payer: Humana KY Medicaid |
$8,128.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,211.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,856.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,823.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,382.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,444.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,441.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,091.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,057.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,913.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,292.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,834.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,801.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,643.42
|
| Rate for Payer: Ohio Health Group HMO |
$17,728.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,486.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,910.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,666.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,564.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,631.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,309.88
|
| Rate for Payer: PHCS Commercial |
$22,692.00
|
| Rate for Payer: PHCS Commercial |
$16,183.58
|
| Rate for Payer: United Healthcare All Payer |
$20,801.00
|
| Rate for Payer: United Healthcare All Payer |
$14,834.95
|
|
|
VIABAHN 6*15*120
|
Facility
|
IP
|
$16,857.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,057.37 |
| Max. Negotiated Rate |
$16,183.58 |
| Rate for Payer: Aetna Commercial |
$12,980.58
|
| Rate for Payer: Aetna Commercial |
$18,200.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,437.25
|
| Rate for Payer: Cash Price |
$8,428.95
|
| Rate for Payer: Cash Price |
$11,818.75
|
| Rate for Payer: Cigna Commercial |
$13,992.06
|
| Rate for Payer: Cigna Commercial |
$19,619.12
|
| Rate for Payer: First Health Commercial |
$22,455.62
|
| Rate for Payer: First Health Commercial |
$16,015.00
|
| Rate for Payer: Humana Commercial |
$20,091.88
|
| Rate for Payer: Humana Commercial |
$14,329.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,823.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,382.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,441.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,444.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,091.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,057.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,834.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,801.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,643.42
|
| Rate for Payer: Ohio Health Group HMO |
$17,728.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,486.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,910.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,666.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,564.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,309.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,631.95
|
| Rate for Payer: PHCS Commercial |
$16,183.58
|
| Rate for Payer: PHCS Commercial |
$22,692.00
|
| Rate for Payer: United Healthcare All Payer |
$14,834.95
|
| Rate for Payer: United Healthcare All Payer |
$20,801.00
|
|
|
VIABAHN 6*2.5*120
|
Facility
|
OP
|
$20,292.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,087.75 |
| Max. Negotiated Rate |
$19,480.80 |
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem Medicaid |
$6,978.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Humana KY Medicaid |
$6,978.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,049.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,118.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
VIABAHN 6*2.5*120
|
Facility
|
IP
|
$20,292.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,087.75 |
| Max. Negotiated Rate |
$19,480.80 |
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
VIABAHN 6*5*120
|
Facility
|
IP
|
$13,919.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,175.74 |
| Max. Negotiated Rate |
$13,362.36 |
| Rate for Payer: Aetna Commercial |
$10,717.73
|
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,856.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$6,959.56
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$11,552.88
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: First Health Commercial |
$13,223.17
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Humana Commercial |
$11,831.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,413.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,272.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,175.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,248.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,439.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,135.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,109.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,604.20
|
| Rate for Payer: PHCS Commercial |
$13,362.36
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$12,248.83
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
VIABAHN 6*5*120
|
Facility
|
OP
|
$13,919.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,175.74 |
| Max. Negotiated Rate |
$13,362.36 |
| Rate for Payer: Aetna Commercial |
$10,717.73
|
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem Medicaid |
$4,786.79
|
| Rate for Payer: Anthem Medicaid |
$6,978.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,856.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$6,959.56
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: Cigna Commercial |
$11,552.88
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: First Health Commercial |
$13,223.17
|
| Rate for Payer: Humana Commercial |
$11,831.26
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Humana KY Medicaid |
$4,786.79
|
| Rate for Payer: Humana KY Medicaid |
$6,978.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,049.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,835.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,413.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,272.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,175.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,882.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,118.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,248.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,439.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,135.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,109.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,604.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: PHCS Commercial |
$13,362.36
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
| Rate for Payer: United Healthcare All Payer |
$12,248.83
|
|
|
VIABAHN 7*10*120
|
Facility
|
IP
|
$21,398.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,419.62 |
| Max. Negotiated Rate |
$20,542.80 |
| Rate for Payer: Aetna Commercial |
$16,477.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,691.03
|
| Rate for Payer: Cash Price |
$10,699.38
|
| Rate for Payer: Cigna Commercial |
$17,760.96
|
| Rate for Payer: First Health Commercial |
$20,328.81
|
| Rate for Payer: Humana Commercial |
$18,188.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,546.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,792.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,419.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,830.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,049.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,616.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,765.14
|
| Rate for Payer: PHCS Commercial |
$20,542.80
|
| Rate for Payer: United Healthcare All Payer |
$18,830.90
|
|
|
VIABAHN 7*10*120
|
Facility
|
OP
|
$21,398.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,419.62 |
| Max. Negotiated Rate |
$20,542.80 |
| Rate for Payer: Aetna Commercial |
$16,477.04
|
| Rate for Payer: Anthem Medicaid |
$7,359.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,691.03
|
| Rate for Payer: Cash Price |
$10,699.38
|
| Rate for Payer: Cigna Commercial |
$17,760.96
|
| Rate for Payer: First Health Commercial |
$20,328.81
|
| Rate for Payer: Humana Commercial |
$18,188.94
|
| Rate for Payer: Humana KY Medicaid |
$7,359.03
|
| Rate for Payer: Kentucky WC Medicaid |
$7,433.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,546.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,792.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,419.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,506.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,830.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,049.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,616.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,765.14
|
| Rate for Payer: PHCS Commercial |
$20,542.80
|
| Rate for Payer: United Healthcare All Payer |
$18,830.90
|
|
|
VIABAHN 7*2.5*120
|
Facility
|
IP
|
$18,300.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.27 |
| Max. Negotiated Rate |
$17,568.86 |
| Rate for Payer: Aetna Commercial |
$14,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,274.70
|
| Rate for Payer: Cash Price |
$9,150.45
|
| Rate for Payer: Cigna Commercial |
$15,189.75
|
| Rate for Payer: First Health Commercial |
$17,385.85
|
| Rate for Payer: Humana Commercial |
$15,555.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,006.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,506.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,490.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,104.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,725.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,640.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,627.62
|
| Rate for Payer: PHCS Commercial |
$17,568.86
|
| Rate for Payer: United Healthcare All Payer |
$16,104.79
|
|
|
VIABAHN 7*2.5*120
|
Facility
|
OP
|
$18,300.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,490.27 |
| Max. Negotiated Rate |
$17,568.86 |
| Rate for Payer: Aetna Commercial |
$14,091.69
|
| Rate for Payer: Anthem Medicaid |
$6,293.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,274.70
|
| Rate for Payer: Cash Price |
$9,150.45
|
| Rate for Payer: Cigna Commercial |
$15,189.75
|
| Rate for Payer: First Health Commercial |
$17,385.85
|
| Rate for Payer: Humana Commercial |
$15,555.76
|
| Rate for Payer: Humana KY Medicaid |
$6,293.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6,357.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,006.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,506.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,490.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,419.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,104.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,725.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,640.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,627.62
|
| Rate for Payer: PHCS Commercial |
$17,568.86
|
| Rate for Payer: United Healthcare All Payer |
$16,104.79
|
|
|
VIABAHN 7*5*120
|
Facility
|
IP
|
$20,292.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,087.75 |
| Max. Negotiated Rate |
$19,480.80 |
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
VIABAHN 7*5*120
|
Facility
|
OP
|
$20,292.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,087.75 |
| Max. Negotiated Rate |
$19,480.80 |
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem Medicaid |
$6,978.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Humana KY Medicaid |
$6,978.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,049.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,118.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
VIABAHN 8*10*120
|
Facility
|
OP
|
$21,398.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,419.62 |
| Max. Negotiated Rate |
$20,542.80 |
| Rate for Payer: Aetna Commercial |
$16,477.04
|
| Rate for Payer: Anthem Medicaid |
$7,359.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,691.03
|
| Rate for Payer: Cash Price |
$10,699.38
|
| Rate for Payer: Cigna Commercial |
$17,760.96
|
| Rate for Payer: First Health Commercial |
$20,328.81
|
| Rate for Payer: Humana Commercial |
$18,188.94
|
| Rate for Payer: Humana KY Medicaid |
$7,359.03
|
| Rate for Payer: Kentucky WC Medicaid |
$7,433.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,546.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,792.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,419.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,506.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,830.90
|
| Rate for Payer: Ohio Health Group HMO |
$16,049.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,616.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,765.14
|
| Rate for Payer: PHCS Commercial |
$20,542.80
|
| Rate for Payer: United Healthcare All Payer |
$18,830.90
|
|
