|
COYOTE BALLOON 2*100*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*120*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*120*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*150*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*150*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
|
|
COYOTE BALLOON 2*220*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*220*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*100*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*100*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*120*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*120*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*150*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*150*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
|
|
COYOTE BALLOON 2.5*220*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*220*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*60*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2.5*60*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*60*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*60*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*60*90
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*60*90
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*80*150 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*80*150 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*80*90
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
COYOTE BALLOON 2*80*90
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
