|
VIABAHN VBX 7*29*80 STENT
|
Facility
|
IP
|
$20,198.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,059.62 |
| Max. Negotiated Rate |
$19,390.80 |
| Rate for Payer: Aetna Commercial |
$15,553.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,755.02
|
| Rate for Payer: Cash Price |
$10,099.38
|
| Rate for Payer: Cigna Commercial |
$16,764.96
|
| Rate for Payer: First Health Commercial |
$19,188.81
|
| Rate for Payer: Humana Commercial |
$17,168.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,562.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,906.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,059.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,774.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,572.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,937.14
|
| Rate for Payer: PHCS Commercial |
$19,390.80
|
| Rate for Payer: United Healthcare All Payer |
$17,774.90
|
|
|
VIABAHN VBX 7*29*80 STENT
|
Facility
|
OP
|
$20,198.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,059.62 |
| Max. Negotiated Rate |
$19,390.80 |
| Rate for Payer: Aetna Commercial |
$15,553.04
|
| Rate for Payer: Anthem Medicaid |
$6,946.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,755.02
|
| Rate for Payer: Cash Price |
$10,099.38
|
| Rate for Payer: Cigna Commercial |
$16,764.96
|
| Rate for Payer: First Health Commercial |
$19,188.81
|
| Rate for Payer: Humana Commercial |
$17,168.94
|
| Rate for Payer: Humana KY Medicaid |
$6,946.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,017.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,562.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,906.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,059.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,085.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,774.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,572.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,937.14
|
| Rate for Payer: PHCS Commercial |
$19,390.80
|
| Rate for Payer: United Healthcare All Payer |
$17,774.90
|
|
|
VIABAHN VBX 7*39*80 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
|
|
|
VIABAHN VBX 7*39*80 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*59*80 STENT
|
Facility
|
OP
|
$20,198.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,059.62 |
| Max. Negotiated Rate |
$19,390.80 |
| Rate for Payer: Aetna Commercial |
$15,553.04
|
| Rate for Payer: Anthem Medicaid |
$6,946.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,755.02
|
| Rate for Payer: Cash Price |
$10,099.38
|
| Rate for Payer: Cigna Commercial |
$16,764.96
|
| Rate for Payer: First Health Commercial |
$19,188.81
|
| Rate for Payer: Humana Commercial |
$17,168.94
|
| Rate for Payer: Humana KY Medicaid |
$6,946.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,017.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,562.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,906.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,059.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,085.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,774.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,572.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,937.14
|
| Rate for Payer: PHCS Commercial |
$19,390.80
|
| Rate for Payer: United Healthcare All Payer |
$17,774.90
|
|
|
VIABAHN VBX 7*59*80 STENT
|
Facility
|
IP
|
$20,198.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,059.62 |
| Max. Negotiated Rate |
$19,390.80 |
| Rate for Payer: Aetna Commercial |
$15,553.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,755.02
|
| Rate for Payer: Cash Price |
$10,099.38
|
| Rate for Payer: Cigna Commercial |
$16,764.96
|
| Rate for Payer: First Health Commercial |
$19,188.81
|
| Rate for Payer: Humana Commercial |
$17,168.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,562.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,906.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,059.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,774.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,159.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,572.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,937.14
|
| Rate for Payer: PHCS Commercial |
$19,390.80
|
| Rate for Payer: United Healthcare All Payer |
$17,774.90
|
|
|
VIABAHN VBX 8*29*80 STENT
|
Facility
|
IP
|
$20,828.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,248.62 |
| Max. Negotiated Rate |
$19,995.60 |
| Rate for Payer: Aetna Commercial |
$16,038.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,246.42
|
| Rate for Payer: Cash Price |
$10,414.38
|
| Rate for Payer: Cigna Commercial |
$17,287.86
|
| Rate for Payer: First Health Commercial |
$19,787.31
|
| Rate for Payer: Humana Commercial |
$17,704.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,079.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,371.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,248.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,329.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,621.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,663.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,121.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,371.84
|
| Rate for Payer: PHCS Commercial |
$19,995.60
|
| Rate for Payer: United Healthcare All Payer |
$18,329.30
|
|
|
VIABAHN VBX 8*29*80 STENT
|
Facility
|
OP
|
$20,828.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,248.62 |
| Max. Negotiated Rate |
$19,995.60 |
| Rate for Payer: Aetna Commercial |
$16,038.14
|
| Rate for Payer: Anthem Medicaid |
$7,163.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,246.42
|
| Rate for Payer: Cash Price |
$10,414.38
|
| Rate for Payer: Cigna Commercial |
$17,287.86
|
| Rate for Payer: First Health Commercial |
$19,787.31
|
| Rate for Payer: Humana Commercial |
$17,704.44
|
| Rate for Payer: Humana KY Medicaid |
$7,163.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,235.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,079.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,371.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,248.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,306.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,329.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,621.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,663.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,121.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,371.84
|
| Rate for Payer: PHCS Commercial |
$19,995.60
|
| Rate for Payer: United Healthcare All Payer |
$18,329.30
|
|
|
VIABAHN VBX 8*39*80
|
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 8*39*80
|
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 8*59*80
|
Facility
|
IP
|
$18,633.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,590.17 |
| Max. Negotiated Rate |
$17,888.54 |
| Rate for Payer: Aetna Commercial |
$14,348.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,534.44
|
| Rate for Payer: Cash Price |
$9,316.95
|
| Rate for Payer: Cigna Commercial |
$15,466.14
|
| Rate for Payer: First Health Commercial |
$17,702.21
|
| Rate for Payer: Humana Commercial |
$15,838.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,279.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,590.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,397.83
|
| Rate for Payer: Ohio Health Group HMO |
$13,975.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,907.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,211.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,857.39
|
| Rate for Payer: PHCS Commercial |
$17,888.54
|
| Rate for Payer: United Healthcare All Payer |
$16,397.83
|
|
|
VIABAHN VBX 8*59*80
|
Facility
|
OP
|
$18,633.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,590.17 |
| Max. Negotiated Rate |
$17,888.54 |
| Rate for Payer: Aetna Commercial |
$14,348.10
|
| Rate for Payer: Anthem Medicaid |
$6,408.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,534.44
|
| Rate for Payer: Cash Price |
$9,316.95
|
| Rate for Payer: Cigna Commercial |
$15,466.14
|
| Rate for Payer: First Health Commercial |
$17,702.21
|
| Rate for Payer: Humana Commercial |
$15,838.82
|
| Rate for Payer: Humana KY Medicaid |
$6,408.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,473.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,279.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,590.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,536.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,397.83
|
| Rate for Payer: Ohio Health Group HMO |
$13,975.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,907.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,211.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,857.39
|
| Rate for Payer: PHCS Commercial |
$17,888.54
|
| Rate for Payer: United Healthcare All Payer |
$16,397.83
|
|
|
VIANCE CATH
|
Facility
|
IP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
VIANCE CATH
|
Facility
|
OP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem Medicaid |
$3,284.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Humana KY Medicaid |
$3,284.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,350.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
VIATORR 6*2
|
Facility
|
IP
|
$22,827.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,848.25 |
| Max. Negotiated Rate |
$21,914.40 |
| Rate for Payer: Aetna Commercial |
$17,577.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,805.45
|
| Rate for Payer: Cash Price |
$11,413.75
|
| Rate for Payer: Cigna Commercial |
$18,946.83
|
| Rate for Payer: First Health Commercial |
$21,686.12
|
| Rate for Payer: Humana Commercial |
$19,403.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,718.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,846.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,848.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,088.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,120.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,859.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,750.98
|
| Rate for Payer: PHCS Commercial |
$21,914.40
|
| Rate for Payer: United Healthcare All Payer |
$20,088.20
|
|
|
VIATORR 6*2
|
Facility
|
OP
|
$22,827.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,848.25 |
| Max. Negotiated Rate |
$21,914.40 |
| Rate for Payer: Aetna Commercial |
$17,577.17
|
| Rate for Payer: Anthem Medicaid |
$7,850.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,805.45
|
| Rate for Payer: Cash Price |
$11,413.75
|
| Rate for Payer: Cigna Commercial |
$18,946.83
|
| Rate for Payer: First Health Commercial |
$21,686.12
|
| Rate for Payer: Humana Commercial |
$19,403.38
|
| Rate for Payer: Humana KY Medicaid |
$7,850.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,930.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,718.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,846.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,848.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,007.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,088.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,120.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,859.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,750.98
|
| Rate for Payer: PHCS Commercial |
$21,914.40
|
| Rate for Payer: United Healthcare All Payer |
$20,088.20
|
|
|
VIATORR 7*2
|
Facility
|
OP
|
$23,540.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,062.00 |
| Max. Negotiated Rate |
$22,598.40 |
| Rate for Payer: Aetna Commercial |
$18,125.80
|
| Rate for Payer: Anthem Medicaid |
$8,095.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,361.20
|
| Rate for Payer: Cash Price |
$11,770.00
|
| Rate for Payer: Cigna Commercial |
$19,538.20
|
| Rate for Payer: First Health Commercial |
$22,363.00
|
| Rate for Payer: Humana Commercial |
$20,009.00
|
| Rate for Payer: Humana KY Medicaid |
$8,095.41
|
| Rate for Payer: Kentucky WC Medicaid |
$8,177.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,302.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,372.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,257.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,715.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,479.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,242.60
|
| Rate for Payer: PHCS Commercial |
$22,598.40
|
| Rate for Payer: United Healthcare All Payer |
$20,715.20
|
|
|
VIATORR 7*2
|
Facility
|
IP
|
$23,540.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,062.00 |
| Max. Negotiated Rate |
$22,598.40 |
| Rate for Payer: Aetna Commercial |
$18,125.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,361.20
|
| Rate for Payer: Cash Price |
$11,770.00
|
| Rate for Payer: Cigna Commercial |
$19,538.20
|
| Rate for Payer: First Health Commercial |
$22,363.00
|
| Rate for Payer: Humana Commercial |
$20,009.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,302.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,372.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,062.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,715.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,479.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,242.60
|
| Rate for Payer: PHCS Commercial |
$22,598.40
|
| Rate for Payer: United Healthcare All Payer |
$20,715.20
|
|
|
VIATORR 8*2
|
Facility
|
IP
|
$22,827.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,848.25 |
| Max. Negotiated Rate |
$21,914.40 |
| Rate for Payer: Aetna Commercial |
$17,577.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,805.45
|
| Rate for Payer: Cash Price |
$11,413.75
|
| Rate for Payer: Cigna Commercial |
$18,946.83
|
| Rate for Payer: First Health Commercial |
$21,686.12
|
| Rate for Payer: Humana Commercial |
$19,403.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,718.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,846.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,848.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,088.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,120.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,859.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,750.98
|
| Rate for Payer: PHCS Commercial |
$21,914.40
|
| Rate for Payer: United Healthcare All Payer |
$20,088.20
|
|
|
VIATORR 8*2
|
Facility
|
OP
|
$22,827.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,848.25 |
| Max. Negotiated Rate |
$21,914.40 |
| Rate for Payer: Aetna Commercial |
$17,577.17
|
| Rate for Payer: Anthem Medicaid |
$7,850.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,805.45
|
| Rate for Payer: Cash Price |
$11,413.75
|
| Rate for Payer: Cigna Commercial |
$18,946.83
|
| Rate for Payer: First Health Commercial |
$21,686.12
|
| Rate for Payer: Humana Commercial |
$19,403.38
|
| Rate for Payer: Humana KY Medicaid |
$7,850.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,930.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,718.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,846.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,848.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,007.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,088.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,120.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,859.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,750.98
|
| Rate for Payer: PHCS Commercial |
$21,914.40
|
| Rate for Payer: United Healthcare All Payer |
$20,088.20
|
|
|
VIBATIV 10 MG( 750MG/50ML)
|
Facility
|
IP
|
$1,598.68
|
|
|
Service Code
|
HCPCS J3095
|
| Hospital Charge Code |
25003873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.60 |
| Max. Negotiated Rate |
$1,534.73 |
| Rate for Payer: Aetna Commercial |
$1,230.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,246.97
|
| Rate for Payer: Cash Price |
$799.34
|
| Rate for Payer: Cigna Commercial |
$1,326.90
|
| Rate for Payer: First Health Commercial |
$1,518.75
|
| Rate for Payer: Humana Commercial |
$1,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,310.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,179.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,406.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,278.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,390.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,103.09
|
| Rate for Payer: PHCS Commercial |
$1,534.73
|
| Rate for Payer: United Healthcare All Payer |
$1,406.84
|
|
|
VIBATIV 10 MG( 750MG/50ML)
|
Facility
|
OP
|
$1,598.68
|
|
|
Service Code
|
HCPCS J3095
|
| Hospital Charge Code |
25003873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$1,534.73 |
| Rate for Payer: Aetna Commercial |
$1,230.98
|
| Rate for Payer: Anthem Medicaid |
$549.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,246.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.08
|
| Rate for Payer: Cash Price |
$799.34
|
| Rate for Payer: Cash Price |
$799.34
|
| Rate for Payer: Cigna Commercial |
$1,326.90
|
| Rate for Payer: First Health Commercial |
$1,518.75
|
| Rate for Payer: Humana Commercial |
$1,358.88
|
| Rate for Payer: Humana KY Medicaid |
$549.79
|
| Rate for Payer: Humana Medicare Advantage |
$7.47
|
| Rate for Payer: Kentucky WC Medicaid |
$555.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,310.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,179.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,406.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,278.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,390.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,103.09
|
| Rate for Payer: PHCS Commercial |
$1,534.73
|
| Rate for Payer: United Healthcare All Payer |
$1,406.84
|
|
|
VIBRAMYCIN (DOXY)1MG(100MGSDV)
|
Facility
|
IP
|
$131.16
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
25003572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.35 |
| Max. Negotiated Rate |
$125.91 |
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.30
|
| Rate for Payer: Cash Price |
$65.58
|
| Rate for Payer: Cigna Commercial |
$108.86
|
| Rate for Payer: First Health Commercial |
$124.60
|
| Rate for Payer: Humana Commercial |
$111.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.42
|
| Rate for Payer: Ohio Health Group HMO |
$98.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.50
|
| Rate for Payer: PHCS Commercial |
$125.91
|
| Rate for Payer: United Healthcare All Payer |
$115.42
|
|
|
VIBRAMYCIN (DOXY)1MG(100MGSDV)
|
Facility
|
OP
|
$131.16
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
25003572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.35 |
| Max. Negotiated Rate |
$125.91 |
| Rate for Payer: Aetna Commercial |
$100.99
|
| Rate for Payer: Anthem Medicaid |
$45.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.30
|
| Rate for Payer: Cash Price |
$65.58
|
| Rate for Payer: Cigna Commercial |
$108.86
|
| Rate for Payer: First Health Commercial |
$124.60
|
| Rate for Payer: Humana Commercial |
$111.49
|
| Rate for Payer: Humana KY Medicaid |
$45.11
|
| Rate for Payer: Kentucky WC Medicaid |
$45.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.42
|
| Rate for Payer: Ohio Health Group HMO |
$98.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.50
|
| Rate for Payer: PHCS Commercial |
$125.91
|
| Rate for Payer: United Healthcare All Payer |
$115.42
|
|
|
VIBRAMYCIN(DOXYCYCL 100MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 53489012005
|
| Hospital Charge Code |
25001666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
