|
CONQ FX FEM COMP SZ 17
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
CONQ FX FEM COMP SZ 18
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
CONQ FX FEM COMP SZ 18
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
CONQ FX FEM COMP SZ 9
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
CONQ FX FEM COMP SZ 9
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
CONQUEST BALLOON 10*4
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 10*4
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 12*4
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 12*4
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
|
|
CONQUEST BALLOON 6*4
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 6*4
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 6*8
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 6*8
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 7*4
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 7*4
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 7*8
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 7*8
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
|
|
CONQUEST BALLOON 8*4
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 8*4
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 8*8
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 8*8
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 9*4
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 9*4
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 9*8
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
CONQUEST BALLOON 9*8
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
