|
GLIDESHEATH SLENDER 7FR
|
Facility
|
OP
|
$1,578.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna Commercial |
$1,215.15
|
| Rate for Payer: Anthem Medicaid |
$542.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.93
|
| Rate for Payer: Cash Price |
$789.06
|
| Rate for Payer: Cigna Commercial |
$1,309.84
|
| Rate for Payer: First Health Commercial |
$1,499.21
|
| Rate for Payer: Humana Commercial |
$1,341.40
|
| Rate for Payer: Humana KY Medicaid |
$542.72
|
| Rate for Payer: Kentucky WC Medicaid |
$548.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.22
|
| Rate for Payer: PHCS Commercial |
$1,515.00
|
| Rate for Payer: United Healthcare All Payer |
$1,388.75
|
|
|
GLIDESHEATH SLENDER 7FR
|
Facility
|
IP
|
$1,578.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna Commercial |
$1,215.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.93
|
| Rate for Payer: Cash Price |
$789.06
|
| Rate for Payer: Cigna Commercial |
$1,309.84
|
| Rate for Payer: First Health Commercial |
$1,499.21
|
| Rate for Payer: Humana Commercial |
$1,341.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.22
|
| Rate for Payer: PHCS Commercial |
$1,515.00
|
| Rate for Payer: United Healthcare All Payer |
$1,388.75
|
|
|
GLIDESHEATH SLENDER AKIT 6FR
|
Facility
|
OP
|
$1,578.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna Commercial |
$1,215.15
|
| Rate for Payer: Anthem Medicaid |
$542.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.93
|
| Rate for Payer: Cash Price |
$789.06
|
| Rate for Payer: Cigna Commercial |
$1,309.84
|
| Rate for Payer: First Health Commercial |
$1,499.21
|
| Rate for Payer: Humana Commercial |
$1,341.40
|
| Rate for Payer: Humana KY Medicaid |
$542.72
|
| Rate for Payer: Kentucky WC Medicaid |
$548.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.22
|
| Rate for Payer: PHCS Commercial |
$1,515.00
|
| Rate for Payer: United Healthcare All Payer |
$1,388.75
|
|
|
GLIDESHEATH SLENDER AKIT 6FR
|
Facility
|
IP
|
$1,578.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,515.00 |
| Rate for Payer: Aetna Commercial |
$1,215.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.93
|
| Rate for Payer: Cash Price |
$789.06
|
| Rate for Payer: Cigna Commercial |
$1,309.84
|
| Rate for Payer: First Health Commercial |
$1,499.21
|
| Rate for Payer: Humana Commercial |
$1,341.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,164.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,388.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,183.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.22
|
| Rate for Payer: PHCS Commercial |
$1,515.00
|
| Rate for Payer: United Healthcare All Payer |
$1,388.75
|
|
|
GLIDEWIRE .035 260CM ANGLED
|
Facility
|
OP
|
$799.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$767.81 |
| Rate for Payer: Aetna Commercial |
$615.85
|
| Rate for Payer: Anthem Medicaid |
$275.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.84
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$663.83
|
| Rate for Payer: First Health Commercial |
$759.81
|
| Rate for Payer: Humana Commercial |
$679.83
|
| Rate for Payer: Humana KY Medicaid |
$275.05
|
| Rate for Payer: Kentucky WC Medicaid |
$277.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.82
|
| Rate for Payer: Ohio Health Group HMO |
$599.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.94
|
| Rate for Payer: PHCS Commercial |
$767.81
|
| Rate for Payer: United Healthcare All Payer |
$703.82
|
|
|
GLIDEWIRE .035 260CM ANGLED
|
Facility
|
IP
|
$799.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$767.81 |
| Rate for Payer: Aetna Commercial |
$615.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.84
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$663.83
|
| Rate for Payer: First Health Commercial |
$759.81
|
| Rate for Payer: Humana Commercial |
$679.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.82
|
| Rate for Payer: Ohio Health Group HMO |
$599.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.94
|
| Rate for Payer: PHCS Commercial |
$767.81
|
| Rate for Payer: United Healthcare All Payer |
$703.82
|
|
|
GLIDEWIRE .035 260CM STRAIGHT
|
Facility
|
IP
|
$799.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$767.81 |
| Rate for Payer: Aetna Commercial |
$615.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.84
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$663.83
|
| Rate for Payer: First Health Commercial |
$759.81
|
| Rate for Payer: Humana Commercial |
$679.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.82
|
| Rate for Payer: Ohio Health Group HMO |
$599.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.94
|
| Rate for Payer: PHCS Commercial |
$767.81
|
| Rate for Payer: United Healthcare All Payer |
$703.82
|
|
|
GLIDEWIRE .035 260CM STRAIGHT
|
Facility
|
OP
|
$799.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$767.81 |
| Rate for Payer: Aetna Commercial |
$615.85
|
| Rate for Payer: Anthem Medicaid |
$275.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.84
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$663.83
|
| Rate for Payer: First Health Commercial |
$759.81
|
| Rate for Payer: Humana Commercial |
$679.83
|
| Rate for Payer: Humana KY Medicaid |
$275.05
|
| Rate for Payer: Kentucky WC Medicaid |
$277.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.82
|
| Rate for Payer: Ohio Health Group HMO |
$599.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.94
|
| Rate for Payer: PHCS Commercial |
$767.81
|
| Rate for Payer: United Healthcare All Payer |
$703.82
|
|
|
GLIDEWIRE .035 260 ST STIFF
|
Facility
|
IP
|
$824.32
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Aetna Commercial |
$634.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.97
|
| Rate for Payer: Cash Price |
$412.16
|
| Rate for Payer: Cigna Commercial |
$684.19
|
| Rate for Payer: First Health Commercial |
$783.10
|
| Rate for Payer: Humana Commercial |
$700.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.40
|
| Rate for Payer: Ohio Health Group HMO |
$618.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.54
|
| Rate for Payer: PHCS Commercial |
$791.35
|
| Rate for Payer: United Healthcare All Payer |
$725.40
|
|
|
GLIDEWIRE .035 260 ST STIFF
|
Facility
|
OP
|
$824.32
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Aetna Commercial |
$634.73
|
| Rate for Payer: Anthem Medicaid |
$283.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.97
|
| Rate for Payer: Cash Price |
$412.16
|
| Rate for Payer: Cigna Commercial |
$684.19
|
| Rate for Payer: First Health Commercial |
$783.10
|
| Rate for Payer: Humana Commercial |
$700.67
|
| Rate for Payer: Humana KY Medicaid |
$283.48
|
| Rate for Payer: Kentucky WC Medicaid |
$286.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.40
|
| Rate for Payer: Ohio Health Group HMO |
$618.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.54
|
| Rate for Payer: PHCS Commercial |
$791.35
|
| Rate for Payer: United Healthcare All Payer |
$725.40
|
|
|
GLIDEWIRE ADV. .035 260CM ANGL
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
GLIDEWIRE ADV. .035 260CM ANGL
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.40 |
| Max. Negotiated Rate |
$1,900.80 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Anthem Medicaid |
$680.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,544.40
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,643.40
|
| Rate for Payer: First Health Commercial |
$1,881.00
|
| Rate for Payer: Humana Commercial |
$1,683.00
|
| Rate for Payer: Humana KY Medicaid |
$680.92
|
| Rate for Payer: Kentucky WC Medicaid |
$687.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,623.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,742.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$613.80
|
| Rate for Payer: PHCS Commercial |
$1,900.80
|
| Rate for Payer: United Healthcare All Payer |
$1,742.40
|
|
|
GLIDEWIRE ADVANTAGE .014
|
Facility
|
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
GLIDEWIRE ADVANTAGE .014
|
Facility
|
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
GLIDEWIRE ADVANTAGE .018 300CM
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
GLIDEWIRE ADVANTAGE .018 300CM
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
GLIDEWIRE ANGLED .018*150CM
|
Facility
|
OP
|
$3,140.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.28 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna Commercial |
$2,418.28
|
| Rate for Payer: Anthem Medicaid |
$1,080.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,449.68
|
| Rate for Payer: Cash Price |
$1,570.31
|
| Rate for Payer: Cigna Commercial |
$2,606.71
|
| Rate for Payer: First Health Commercial |
$2,983.59
|
| Rate for Payer: Humana Commercial |
$2,669.53
|
| Rate for Payer: Humana KY Medicaid |
$1,080.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,091.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,575.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,317.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,763.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,355.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$973.59
|
| Rate for Payer: PHCS Commercial |
$3,015.00
|
| Rate for Payer: United Healthcare All Payer |
$2,763.75
|
|
|
GLIDEWIRE ANGLED .018*150CM
|
Facility
|
IP
|
$3,140.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.28 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna Commercial |
$2,418.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,449.68
|
| Rate for Payer: Cash Price |
$1,570.31
|
| Rate for Payer: Cigna Commercial |
$2,606.71
|
| Rate for Payer: First Health Commercial |
$2,983.59
|
| Rate for Payer: Humana Commercial |
$2,669.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,575.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,317.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,763.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,355.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$973.59
|
| Rate for Payer: PHCS Commercial |
$3,015.00
|
| Rate for Payer: United Healthcare All Payer |
$2,763.75
|
|
|
GLIDEWIRE ANGLED .035*180CM
|
Facility
|
IP
|
$778.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$599.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$607.35
|
| Rate for Payer: Cash Price |
$389.32
|
| Rate for Payer: Cigna Commercial |
$646.28
|
| Rate for Payer: First Health Commercial |
$739.72
|
| Rate for Payer: Humana Commercial |
$661.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$638.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$685.21
|
| Rate for Payer: Ohio Health Group HMO |
$583.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.38
|
| Rate for Payer: PHCS Commercial |
$747.50
|
| Rate for Payer: United Healthcare All Payer |
$685.21
|
|
|
GLIDEWIRE ANGLED .035*180CM
|
Facility
|
OP
|
$778.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$599.56
|
| Rate for Payer: Anthem Medicaid |
$267.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$607.35
|
| Rate for Payer: Cash Price |
$389.32
|
| Rate for Payer: Cigna Commercial |
$646.28
|
| Rate for Payer: First Health Commercial |
$739.72
|
| Rate for Payer: Humana Commercial |
$661.85
|
| Rate for Payer: Humana KY Medicaid |
$267.78
|
| Rate for Payer: Kentucky WC Medicaid |
$270.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$638.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$685.21
|
| Rate for Payer: Ohio Health Group HMO |
$583.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.38
|
| Rate for Payer: PHCS Commercial |
$747.50
|
| Rate for Payer: United Healthcare All Payer |
$685.21
|
|
|
GLIDEWIRE GOLD .018
|
Facility
|
OP
|
$1,771.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.33 |
| Max. Negotiated Rate |
$1,700.88 |
| Rate for Payer: Aetna Commercial |
$1,364.25
|
| Rate for Payer: Anthem Medicaid |
$609.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.96
|
| Rate for Payer: Cash Price |
$885.88
|
| Rate for Payer: Cigna Commercial |
$1,470.55
|
| Rate for Payer: First Health Commercial |
$1,683.16
|
| Rate for Payer: Humana Commercial |
$1,505.99
|
| Rate for Payer: Humana KY Medicaid |
$609.30
|
| Rate for Payer: Kentucky WC Medicaid |
$615.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,559.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$1,700.88
|
| Rate for Payer: United Healthcare All Payer |
$1,559.14
|
|
|
GLIDEWIRE GOLD .018
|
Facility
|
IP
|
$1,771.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.33 |
| Max. Negotiated Rate |
$1,700.88 |
| Rate for Payer: Aetna Commercial |
$1,364.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.96
|
| Rate for Payer: Cash Price |
$885.88
|
| Rate for Payer: Cigna Commercial |
$1,470.55
|
| Rate for Payer: First Health Commercial |
$1,683.16
|
| Rate for Payer: Humana Commercial |
$1,505.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,559.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$1,700.88
|
| Rate for Payer: United Healthcare All Payer |
$1,559.14
|
|
|
GLIDEWIRE SS STRAIGHT .035*180
|
Facility
|
OP
|
$765.03
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.43 |
| Rate for Payer: Aetna Commercial |
$589.07
|
| Rate for Payer: Anthem Medicaid |
$263.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.72
|
| Rate for Payer: Cash Price |
$382.52
|
| Rate for Payer: Cigna Commercial |
$634.97
|
| Rate for Payer: First Health Commercial |
$726.78
|
| Rate for Payer: Humana Commercial |
$650.28
|
| Rate for Payer: Humana KY Medicaid |
$263.09
|
| Rate for Payer: Kentucky WC Medicaid |
$265.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.23
|
| Rate for Payer: Ohio Health Group HMO |
$573.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.16
|
| Rate for Payer: PHCS Commercial |
$734.43
|
| Rate for Payer: United Healthcare All Payer |
$673.23
|
|
|
GLIDEWIRE SS STRAIGHT .035*180
|
Facility
|
IP
|
$765.03
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.43 |
| Rate for Payer: Aetna Commercial |
$589.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.72
|
| Rate for Payer: Cash Price |
$382.52
|
| Rate for Payer: Cigna Commercial |
$634.97
|
| Rate for Payer: First Health Commercial |
$726.78
|
| Rate for Payer: Humana Commercial |
$650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.23
|
| Rate for Payer: Ohio Health Group HMO |
$573.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.16
|
| Rate for Payer: PHCS Commercial |
$734.43
|
| Rate for Payer: United Healthcare All Payer |
$673.23
|
|
|
GLIDEWIRE STD 0.35*180 STRGHT
|
Facility
|
OP
|
$778.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$599.56
|
| Rate for Payer: Anthem Medicaid |
$267.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$607.35
|
| Rate for Payer: Cash Price |
$389.32
|
| Rate for Payer: Cigna Commercial |
$646.28
|
| Rate for Payer: First Health Commercial |
$739.72
|
| Rate for Payer: Humana Commercial |
$661.85
|
| Rate for Payer: Humana KY Medicaid |
$267.78
|
| Rate for Payer: Kentucky WC Medicaid |
$270.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$638.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$685.21
|
| Rate for Payer: Ohio Health Group HMO |
$583.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.38
|
| Rate for Payer: PHCS Commercial |
$747.50
|
| Rate for Payer: United Healthcare All Payer |
$685.21
|
|
