|
TAKERU OTW BALLOON 2*15
|
Facility
|
IP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU OTW BALLOON 2*20
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU OTW BALLOON 2*20
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU OTW BALLOON 2*8
|
Facility
|
IP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU OTW BALLOON 2*8
|
Facility
|
OP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem Medicaid |
$597.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Humana KY Medicaid |
$597.87
|
| Rate for Payer: Kentucky WC Medicaid |
$603.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 1.5*12
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 1.5*12
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 1.5*15
|
Facility
|
OP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem Medicaid |
$597.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Humana KY Medicaid |
$597.87
|
| Rate for Payer: Kentucky WC Medicaid |
$603.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 1.5*15
|
Facility
|
IP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 1.5*6
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 1.5*6
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2*12
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2*12
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2*15
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2*15
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2*20
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2*20
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2.25*12
|
Facility
|
IP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 2.25*12
|
Facility
|
OP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem Medicaid |
$597.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Humana KY Medicaid |
$597.87
|
| Rate for Payer: Kentucky WC Medicaid |
$603.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 2.25*15
|
Facility
|
OP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem Medicaid |
$597.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Humana KY Medicaid |
$597.87
|
| Rate for Payer: Kentucky WC Medicaid |
$603.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 2.25*15
|
Facility
|
IP
|
$1,738.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.96 |
| Rate for Payer: Aetna Commercial |
$1,338.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.03
|
| Rate for Payer: Cash Price |
$869.25
|
| Rate for Payer: Cigna Commercial |
$1,442.96
|
| Rate for Payer: First Health Commercial |
$1,651.58
|
| Rate for Payer: Humana Commercial |
$1,477.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.94
|
| Rate for Payer: PHCS Commercial |
$1,668.96
|
| Rate for Payer: United Healthcare All Payer |
$1,529.88
|
|
|
TAKERU RX BALLOON 2.25*20
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2.25*20
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2.5*12
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
TAKERU RX BALLOON 2.5*12
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
