|
VIABAHN 8*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 8*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 8*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 8*5*120
|
Facility
|
OP
|
$19,192.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,757.78 |
| Max. Negotiated Rate |
$18,424.90 |
| Rate for Payer: Aetna Commercial |
$14,778.30
|
| Rate for Payer: Anthem Medicaid |
$6,600.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,970.23
|
| Rate for Payer: Cash Price |
$9,596.30
|
| Rate for Payer: Cigna Commercial |
$15,929.86
|
| Rate for Payer: First Health Commercial |
$18,232.97
|
| Rate for Payer: Humana Commercial |
$16,313.71
|
| Rate for Payer: Humana KY Medicaid |
$6,600.34
|
| Rate for Payer: Kentucky WC Medicaid |
$6,667.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,737.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,164.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,757.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,732.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,889.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,394.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,354.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,697.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,242.89
|
| Rate for Payer: PHCS Commercial |
$18,424.90
|
| Rate for Payer: United Healthcare All Payer |
$16,889.49
|
|
|
VIABAHN 8*5*120
|
Facility
|
IP
|
$19,192.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,757.78 |
| Max. Negotiated Rate |
$18,424.90 |
| Rate for Payer: Aetna Commercial |
$14,778.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,970.23
|
| Rate for Payer: Cash Price |
$9,596.30
|
| Rate for Payer: Cigna Commercial |
$15,929.86
|
| Rate for Payer: First Health Commercial |
$18,232.97
|
| Rate for Payer: Humana Commercial |
$16,313.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,737.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,164.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,757.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,889.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,394.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,354.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,697.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,242.89
|
| Rate for Payer: PHCS Commercial |
$18,424.90
|
| Rate for Payer: United Healthcare All Payer |
$16,889.49
|
|
|
VIABAHN BALLOON 8*59MM 8FR 135
|
Facility
|
IP
|
$18,152.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,445.87 |
| Max. Negotiated Rate |
$17,426.78 |
| Rate for Payer: Aetna Commercial |
$13,977.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,159.26
|
| Rate for Payer: Cash Price |
$9,076.45
|
| Rate for Payer: Cigna Commercial |
$15,066.91
|
| Rate for Payer: First Health Commercial |
$17,245.26
|
| Rate for Payer: Humana Commercial |
$15,429.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,396.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,445.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,974.55
|
| Rate for Payer: Ohio Health Group HMO |
$13,614.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,522.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,793.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.50
|
| Rate for Payer: PHCS Commercial |
$17,426.78
|
| Rate for Payer: United Healthcare All Payer |
$15,974.55
|
|
|
VIABAHN BALLOON 8*59MM 8FR 135
|
Facility
|
OP
|
$18,152.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,445.87 |
| Max. Negotiated Rate |
$17,426.78 |
| Rate for Payer: Aetna Commercial |
$13,977.73
|
| Rate for Payer: Anthem Medicaid |
$6,242.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,159.26
|
| Rate for Payer: Cash Price |
$9,076.45
|
| Rate for Payer: Cigna Commercial |
$15,066.91
|
| Rate for Payer: First Health Commercial |
$17,245.26
|
| Rate for Payer: Humana Commercial |
$15,429.97
|
| Rate for Payer: Humana KY Medicaid |
$6,242.78
|
| Rate for Payer: Kentucky WC Medicaid |
$6,306.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,396.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,445.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,368.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,974.55
|
| Rate for Payer: Ohio Health Group HMO |
$13,614.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,522.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,793.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.50
|
| Rate for Payer: PHCS Commercial |
$17,426.78
|
| Rate for Payer: United Healthcare All Payer |
$15,974.55
|
|
|
VIABAHN VBX 11*39*135 STENT
|
Facility
|
IP
|
$19,103.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,731.14 |
| Max. Negotiated Rate |
$18,339.65 |
| Rate for Payer: Aetna Commercial |
$14,709.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,900.96
|
| Rate for Payer: Cash Price |
$9,551.90
|
| Rate for Payer: Cigna Commercial |
$15,856.15
|
| Rate for Payer: First Health Commercial |
$18,148.61
|
| Rate for Payer: Humana Commercial |
$16,238.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,665.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,098.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,731.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,811.34
|
| Rate for Payer: Ohio Health Group HMO |
$14,327.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,283.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,181.62
|
| Rate for Payer: PHCS Commercial |
$18,339.65
|
| Rate for Payer: United Healthcare All Payer |
$16,811.34
|
|
|
VIABAHN VBX 11*39*135 STENT
|
Facility
|
OP
|
$19,103.80
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,731.14 |
| Max. Negotiated Rate |
$18,339.65 |
| Rate for Payer: Aetna Commercial |
$14,709.93
|
| Rate for Payer: Anthem Medicaid |
$6,569.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,900.96
|
| Rate for Payer: Cash Price |
$9,551.90
|
| Rate for Payer: Cigna Commercial |
$15,856.15
|
| Rate for Payer: First Health Commercial |
$18,148.61
|
| Rate for Payer: Humana Commercial |
$16,238.23
|
| Rate for Payer: Humana KY Medicaid |
$6,569.80
|
| Rate for Payer: Kentucky WC Medicaid |
$6,636.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,665.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,098.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,731.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,701.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,811.34
|
| Rate for Payer: Ohio Health Group HMO |
$14,327.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,283.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,181.62
|
| Rate for Payer: PHCS Commercial |
$18,339.65
|
| Rate for Payer: United Healthcare All Payer |
$16,811.34
|
|
|
VIABAHN VBX 5*19*135 STENT
|
Facility
|
OP
|
$13,618.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$13,073.46 |
| Rate for Payer: Aetna Commercial |
$10,486.01
|
| Rate for Payer: Anthem Medicaid |
$4,683.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,622.19
|
| Rate for Payer: Cash Price |
$6,809.10
|
| Rate for Payer: Cigna Commercial |
$11,303.10
|
| Rate for Payer: First Health Commercial |
$12,937.28
|
| Rate for Payer: Humana Commercial |
$11,575.46
|
| Rate for Payer: Humana KY Medicaid |
$4,683.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,730.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,166.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,050.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,085.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,777.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,984.01
|
| Rate for Payer: Ohio Health Group HMO |
$10,213.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,894.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,847.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,396.55
|
| Rate for Payer: PHCS Commercial |
$13,073.46
|
| Rate for Payer: United Healthcare All Payer |
$11,984.01
|
|
|
VIABAHN VBX 5*19*135 STENT
|
Facility
|
IP
|
$13,618.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$13,073.46 |
| Rate for Payer: Aetna Commercial |
$10,486.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,622.19
|
| Rate for Payer: Cash Price |
$6,809.10
|
| Rate for Payer: Cigna Commercial |
$11,303.10
|
| Rate for Payer: First Health Commercial |
$12,937.28
|
| Rate for Payer: Humana Commercial |
$11,575.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,166.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,050.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,085.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,984.01
|
| Rate for Payer: Ohio Health Group HMO |
$10,213.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,894.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,847.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,396.55
|
| Rate for Payer: PHCS Commercial |
$13,073.46
|
| Rate for Payer: United Healthcare All Payer |
$11,984.01
|
|
|
VIABAHN VBX 6*15*135 STENT
|
Facility
|
OP
|
$13,618.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$13,073.46 |
| Rate for Payer: Aetna Commercial |
$10,486.01
|
| Rate for Payer: Anthem Medicaid |
$4,683.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,622.19
|
| Rate for Payer: Cash Price |
$6,809.10
|
| Rate for Payer: Cigna Commercial |
$11,303.10
|
| Rate for Payer: First Health Commercial |
$12,937.28
|
| Rate for Payer: Humana Commercial |
$11,575.46
|
| Rate for Payer: Humana KY Medicaid |
$4,683.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,730.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,166.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,050.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,085.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,777.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,984.01
|
| Rate for Payer: Ohio Health Group HMO |
$10,213.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,894.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,847.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,396.55
|
| Rate for Payer: PHCS Commercial |
$13,073.46
|
| Rate for Payer: United Healthcare All Payer |
$11,984.01
|
|
|
VIABAHN VBX 6*15*135 STENT
|
Facility
|
IP
|
$13,618.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$13,073.46 |
| Rate for Payer: Aetna Commercial |
$10,486.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,622.19
|
| Rate for Payer: Cash Price |
$6,809.10
|
| Rate for Payer: Cigna Commercial |
$11,303.10
|
| Rate for Payer: First Health Commercial |
$12,937.28
|
| Rate for Payer: Humana Commercial |
$11,575.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,166.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,050.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,085.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,984.01
|
| Rate for Payer: Ohio Health Group HMO |
$10,213.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,894.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,847.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,396.55
|
| Rate for Payer: PHCS Commercial |
$13,073.46
|
| Rate for Payer: United Healthcare All Payer |
$11,984.01
|
|
|
VIABAHN VBX 6*19*135 STENT
|
Facility
|
IP
|
$13,618.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$13,073.46 |
| Rate for Payer: Aetna Commercial |
$10,486.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,622.19
|
| Rate for Payer: Cash Price |
$6,809.10
|
| Rate for Payer: Cigna Commercial |
$11,303.10
|
| Rate for Payer: First Health Commercial |
$12,937.28
|
| Rate for Payer: Humana Commercial |
$11,575.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,166.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,050.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,085.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,984.01
|
| Rate for Payer: Ohio Health Group HMO |
$10,213.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,894.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,847.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,396.55
|
| Rate for Payer: PHCS Commercial |
$13,073.46
|
| Rate for Payer: United Healthcare All Payer |
$11,984.01
|
|
|
VIABAHN VBX 6*19*135 STENT
|
Facility
|
OP
|
$13,618.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$13,073.46 |
| Rate for Payer: Aetna Commercial |
$10,486.01
|
| Rate for Payer: Anthem Medicaid |
$4,683.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,622.19
|
| Rate for Payer: Cash Price |
$6,809.10
|
| Rate for Payer: Cigna Commercial |
$11,303.10
|
| Rate for Payer: First Health Commercial |
$12,937.28
|
| Rate for Payer: Humana Commercial |
$11,575.46
|
| Rate for Payer: Humana KY Medicaid |
$4,683.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,730.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,166.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,050.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,085.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,777.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,984.01
|
| Rate for Payer: Ohio Health Group HMO |
$10,213.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,894.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,847.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,396.55
|
| Rate for Payer: PHCS Commercial |
$13,073.46
|
| Rate for Payer: United Healthcare All Payer |
$11,984.01
|
|
|
VIABAHN VBX 6*29*135 STENT
|
Facility
|
IP
|
$16,743.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.96 |
| Max. Negotiated Rate |
$16,073.47 |
| Rate for Payer: Aetna Commercial |
$12,892.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,059.70
|
| Rate for Payer: Cash Price |
$8,371.60
|
| Rate for Payer: Cigna Commercial |
$13,896.86
|
| Rate for Payer: First Health Commercial |
$15,906.04
|
| Rate for Payer: Humana Commercial |
$14,231.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,729.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,356.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,022.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,734.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,394.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,566.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,552.81
|
| Rate for Payer: PHCS Commercial |
$16,073.47
|
| Rate for Payer: United Healthcare All Payer |
$14,734.02
|
|
|
VIABAHN VBX 6*29*135 STENT
|
Facility
|
OP
|
$16,743.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.96 |
| Max. Negotiated Rate |
$16,073.47 |
| Rate for Payer: Aetna Commercial |
$12,892.26
|
| Rate for Payer: Anthem Medicaid |
$5,757.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,059.70
|
| Rate for Payer: Cash Price |
$8,371.60
|
| Rate for Payer: Cigna Commercial |
$13,896.86
|
| Rate for Payer: First Health Commercial |
$15,906.04
|
| Rate for Payer: Humana Commercial |
$14,231.72
|
| Rate for Payer: Humana KY Medicaid |
$5,757.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,816.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,729.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,356.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,022.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,873.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,734.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,394.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,566.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,552.81
|
| Rate for Payer: PHCS Commercial |
$16,073.47
|
| Rate for Payer: United Healthcare All Payer |
$14,734.02
|
|
|
VIABAHN VBX 6*39*135 STENT
|
Facility
|
IP
|
$16,743.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.96 |
| Max. Negotiated Rate |
$16,073.47 |
| Rate for Payer: Aetna Commercial |
$12,892.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,059.70
|
| Rate for Payer: Cash Price |
$8,371.60
|
| Rate for Payer: Cigna Commercial |
$13,896.86
|
| Rate for Payer: First Health Commercial |
$15,906.04
|
| Rate for Payer: Humana Commercial |
$14,231.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,729.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,356.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,022.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,734.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,394.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,566.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,552.81
|
| Rate for Payer: PHCS Commercial |
$16,073.47
|
| Rate for Payer: United Healthcare All Payer |
$14,734.02
|
|
|
VIABAHN VBX 6*39*135 STENT
|
Facility
|
OP
|
$16,743.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.96 |
| Max. Negotiated Rate |
$16,073.47 |
| Rate for Payer: Aetna Commercial |
$12,892.26
|
| Rate for Payer: Anthem Medicaid |
$5,757.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,059.70
|
| Rate for Payer: Cash Price |
$8,371.60
|
| Rate for Payer: Cigna Commercial |
$13,896.86
|
| Rate for Payer: First Health Commercial |
$15,906.04
|
| Rate for Payer: Humana Commercial |
$14,231.72
|
| Rate for Payer: Humana KY Medicaid |
$5,757.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,816.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,729.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,356.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,022.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,873.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,734.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,394.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,566.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,552.81
|
| Rate for Payer: PHCS Commercial |
$16,073.47
|
| Rate for Payer: United Healthcare All Payer |
$14,734.02
|
|
|
VIABAHN VBX 6*59*135 STENT
|
Facility
|
IP
|
$16,743.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.96 |
| Max. Negotiated Rate |
$16,073.47 |
| Rate for Payer: Aetna Commercial |
$12,892.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,059.70
|
| Rate for Payer: Cash Price |
$8,371.60
|
| Rate for Payer: Cigna Commercial |
$13,896.86
|
| Rate for Payer: First Health Commercial |
$15,906.04
|
| Rate for Payer: Humana Commercial |
$14,231.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,729.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,356.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,022.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,734.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,394.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,566.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,552.81
|
| Rate for Payer: PHCS Commercial |
$16,073.47
|
| Rate for Payer: United Healthcare All Payer |
$14,734.02
|
|
|
VIABAHN VBX 6*59*135 STENT
|
Facility
|
OP
|
$16,743.20
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,022.96 |
| Max. Negotiated Rate |
$16,073.47 |
| Rate for Payer: Aetna Commercial |
$12,892.26
|
| Rate for Payer: Anthem Medicaid |
$5,757.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,059.70
|
| Rate for Payer: Cash Price |
$8,371.60
|
| Rate for Payer: Cigna Commercial |
$13,896.86
|
| Rate for Payer: First Health Commercial |
$15,906.04
|
| Rate for Payer: Humana Commercial |
$14,231.72
|
| Rate for Payer: Humana KY Medicaid |
$5,757.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,816.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,729.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,356.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,022.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,873.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,734.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,394.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,566.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,552.81
|
| Rate for Payer: PHCS Commercial |
$16,073.47
|
| Rate for Payer: United Healthcare All Payer |
$14,734.02
|
|
|
VIABAHN VBX 6*79*135 STENT
|
Facility
|
IP
|
$18,907.70
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,672.31 |
| Max. Negotiated Rate |
$18,151.39 |
| Rate for Payer: Aetna Commercial |
$14,558.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,748.01
|
| Rate for Payer: Cash Price |
$9,453.85
|
| Rate for Payer: Cigna Commercial |
$15,693.39
|
| Rate for Payer: First Health Commercial |
$17,962.31
|
| Rate for Payer: Humana Commercial |
$16,071.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,504.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,953.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,672.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,638.78
|
| Rate for Payer: Ohio Health Group HMO |
$14,180.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,126.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,449.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,046.31
|
| Rate for Payer: PHCS Commercial |
$18,151.39
|
| Rate for Payer: United Healthcare All Payer |
$16,638.78
|
|
|
VIABAHN VBX 6*79*135 STENT
|
Facility
|
OP
|
$18,907.70
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,672.31 |
| Max. Negotiated Rate |
$18,151.39 |
| Rate for Payer: Aetna Commercial |
$14,558.93
|
| Rate for Payer: Anthem Medicaid |
$6,502.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,748.01
|
| Rate for Payer: Cash Price |
$9,453.85
|
| Rate for Payer: Cigna Commercial |
$15,693.39
|
| Rate for Payer: First Health Commercial |
$17,962.31
|
| Rate for Payer: Humana Commercial |
$16,071.55
|
| Rate for Payer: Humana KY Medicaid |
$6,502.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,568.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,504.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,953.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,672.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,638.78
|
| Rate for Payer: Ohio Health Group HMO |
$14,180.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,126.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,449.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,046.31
|
| Rate for Payer: PHCS Commercial |
$18,151.39
|
| Rate for Payer: United Healthcare All Payer |
$16,638.78
|
|
|
VIABAHN VBX 7*19*135 STENT
|
Facility
|
IP
|
$16,802.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.72 |
| Max. Negotiated Rate |
$16,130.30 |
| Rate for Payer: Aetna Commercial |
$12,937.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,105.87
|
| Rate for Payer: Cash Price |
$8,401.20
|
| Rate for Payer: Cigna Commercial |
$13,945.99
|
| Rate for Payer: First Health Commercial |
$15,962.28
|
| Rate for Payer: Humana Commercial |
$14,282.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,777.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,400.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,786.11
|
| Rate for Payer: Ohio Health Group HMO |
$12,601.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,441.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,618.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,593.66
|
| Rate for Payer: PHCS Commercial |
$16,130.30
|
| Rate for Payer: United Healthcare All Payer |
$14,786.11
|
|
|
VIABAHN VBX 7*19*135 STENT
|
Facility
|
OP
|
$16,802.40
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.72 |
| Max. Negotiated Rate |
$16,130.30 |
| Rate for Payer: Aetna Commercial |
$12,937.85
|
| Rate for Payer: Anthem Medicaid |
$5,778.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,105.87
|
| Rate for Payer: Cash Price |
$8,401.20
|
| Rate for Payer: Cigna Commercial |
$13,945.99
|
| Rate for Payer: First Health Commercial |
$15,962.28
|
| Rate for Payer: Humana Commercial |
$14,282.04
|
| Rate for Payer: Humana KY Medicaid |
$5,778.35
|
| Rate for Payer: Kentucky WC Medicaid |
$5,837.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,777.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,400.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,894.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,786.11
|
| Rate for Payer: Ohio Health Group HMO |
$12,601.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,441.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,618.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,593.66
|
| Rate for Payer: PHCS Commercial |
$16,130.30
|
| Rate for Payer: United Healthcare All Payer |
$14,786.11
|
|
