|
GUIDEWIRE
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
GUIDEWIRE
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
GUIDEWIRE .028*4 SHORT
|
Facility
|
OP
|
$436.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Humana KY Medicaid |
$150.11
|
| Rate for Payer: Kentucky WC Medicaid |
$151.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
GUIDEWIRE .028*4 SHORT
|
Facility
|
IP
|
$436.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
GUIDE WIRE .028*6
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem Medicaid |
$152.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Humana KY Medicaid |
$152.35
|
| Rate for Payer: Kentucky WC Medicaid |
$153.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
GUIDE WIRE .028*6
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
GUIDEWIRE .035*5.75 ST WS-0906
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
GUIDEWIRE .035*5.75 ST WS-0906
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem Medicaid |
$152.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Humana KY Medicaid |
$152.35
|
| Rate for Payer: Kentucky WC Medicaid |
$153.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
GUIDEWIRE .035*5CM*180CM
|
Facility
|
OP
|
$1,112.73
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,068.22 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Anthem Medicaid |
$382.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$867.93
|
| Rate for Payer: Cash Price |
$556.36
|
| Rate for Payer: Cigna Commercial |
$923.57
|
| Rate for Payer: First Health Commercial |
$1,057.09
|
| Rate for Payer: Humana Commercial |
$945.82
|
| Rate for Payer: Humana KY Medicaid |
$382.67
|
| Rate for Payer: Kentucky WC Medicaid |
$386.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$912.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$821.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$979.20
|
| Rate for Payer: Ohio Health Group HMO |
$834.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.95
|
| Rate for Payer: PHCS Commercial |
$1,068.22
|
| Rate for Payer: United Healthcare All Payer |
$979.20
|
|
|
GUIDEWIRE .035*5CM*180CM
|
Facility
|
IP
|
$1,112.73
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$1,068.22 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$867.93
|
| Rate for Payer: Cash Price |
$556.36
|
| Rate for Payer: Cigna Commercial |
$923.57
|
| Rate for Payer: First Health Commercial |
$1,057.09
|
| Rate for Payer: Humana Commercial |
$945.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$912.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$821.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$979.20
|
| Rate for Payer: Ohio Health Group HMO |
$834.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.95
|
| Rate for Payer: PHCS Commercial |
$1,068.22
|
| Rate for Payer: United Healthcare All Payer |
$979.20
|
|
|
GUIDEWIRE .035*5CM*260CM
|
Facility
|
IP
|
$1,099.27
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.91 |
| Max. Negotiated Rate |
$1,055.30 |
| Rate for Payer: Aetna Commercial |
$846.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$857.43
|
| Rate for Payer: Cash Price |
$549.64
|
| Rate for Payer: Cigna Commercial |
$912.39
|
| Rate for Payer: First Health Commercial |
$1,044.31
|
| Rate for Payer: Humana Commercial |
$934.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$901.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$967.36
|
| Rate for Payer: Ohio Health Group HMO |
$824.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.77
|
| Rate for Payer: PHCS Commercial |
$1,055.30
|
| Rate for Payer: United Healthcare All Payer |
$967.36
|
|
|
GUIDEWIRE .035*5CM*260CM
|
Facility
|
OP
|
$1,099.27
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.91 |
| Max. Negotiated Rate |
$1,055.30 |
| Rate for Payer: Aetna Commercial |
$846.44
|
| Rate for Payer: Anthem Medicaid |
$378.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$857.43
|
| Rate for Payer: Cash Price |
$549.64
|
| Rate for Payer: Cigna Commercial |
$912.39
|
| Rate for Payer: First Health Commercial |
$1,044.31
|
| Rate for Payer: Humana Commercial |
$934.38
|
| Rate for Payer: Humana KY Medicaid |
$378.04
|
| Rate for Payer: Kentucky WC Medicaid |
$381.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$901.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$967.36
|
| Rate for Payer: Ohio Health Group HMO |
$824.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.77
|
| Rate for Payer: PHCS Commercial |
$1,055.30
|
| Rate for Payer: United Healthcare All Payer |
$967.36
|
|
|
GUIDEWIRE .035*6 DBL 80-1525
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna Commercial |
$351.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$355.68
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$378.48
|
| Rate for Payer: First Health Commercial |
$433.20
|
| Rate for Payer: Humana Commercial |
$387.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$336.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$401.28
|
| Rate for Payer: Ohio Health Group HMO |
$342.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.36
|
| Rate for Payer: PHCS Commercial |
$437.76
|
| Rate for Payer: United Healthcare All Payer |
$401.28
|
|
|
GUIDEWIRE .035*6 DBL 80-1525
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna Commercial |
$351.12
|
| Rate for Payer: Anthem Medicaid |
$156.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$355.68
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$378.48
|
| Rate for Payer: First Health Commercial |
$433.20
|
| Rate for Payer: Humana Commercial |
$387.60
|
| Rate for Payer: Humana KY Medicaid |
$156.82
|
| Rate for Payer: Kentucky WC Medicaid |
$158.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$336.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$401.28
|
| Rate for Payer: Ohio Health Group HMO |
$342.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.36
|
| Rate for Payer: PHCS Commercial |
$437.76
|
| Rate for Payer: United Healthcare All Payer |
$401.28
|
|
|
GUIDEWIRE .035*6 SNGL 80-1524
|
Facility
|
OP
|
$811.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
GUIDEWIRE .035*6 SNGL 80-1524
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
GUIDEWIRE .035 ACUMED
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE .035 ACUMED
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE .045*5.75 STT
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
GUIDEWIRE .045*5.75 STT
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem Medicaid |
$188.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Humana KY Medicaid |
$188.11
|
| Rate for Payer: Kentucky WC Medicaid |
$190.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
GUIDEWIRE .045*6 ST WS-1106ST
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem Medicaid |
$262.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Humana KY Medicaid |
$262.05
|
| Rate for Payer: Kentucky WC Medicaid |
$264.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
GUIDEWIRE .045*6 ST WS-1106ST
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
GUIDEWIRE .045 ACUMED
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE .045 ACUMED
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE .054*6 WS-1406ST
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
