|
GUIDEWIRE .054*6 WS-1406ST
|
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 .054*7 ST WS-1407ST
|
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 .054*7 ST WS-1407ST
|
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 .062*12 IN
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .062*12 IN
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .062*6 IN
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .062*6 IN
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE 062*6 WS-1607ST
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem Medicaid |
$161.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Humana KY Medicaid |
$161.29
|
| Rate for Payer: Kentucky WC Medicaid |
$162.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.39
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
GUIDEWIRE 062*6 WS-1607ST
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.39
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
GUIDEWIRE .062*7 IN
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .062*7 IN
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .062* 9.25MM
|
Facility
|
OP
|
$449.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$346.12
|
| Rate for Payer: Anthem Medicaid |
$154.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.61
|
| Rate for Payer: Cash Price |
$224.75
|
| Rate for Payer: Cigna Commercial |
$373.08
|
| Rate for Payer: First Health Commercial |
$427.02
|
| Rate for Payer: Humana Commercial |
$382.08
|
| Rate for Payer: Humana KY Medicaid |
$154.58
|
| Rate for Payer: Kentucky WC Medicaid |
$156.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.56
|
| Rate for Payer: Ohio Health Group HMO |
$337.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.34
|
| Rate for Payer: PHCS Commercial |
$431.52
|
| Rate for Payer: United Healthcare All Payer |
$395.56
|
|
|
GUIDEWIRE .062* 9.25MM
|
Facility
|
IP
|
$449.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$346.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.61
|
| Rate for Payer: Cash Price |
$224.75
|
| Rate for Payer: Cigna Commercial |
$373.08
|
| Rate for Payer: First Health Commercial |
$427.02
|
| Rate for Payer: Humana Commercial |
$382.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.56
|
| Rate for Payer: Ohio Health Group HMO |
$337.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.34
|
| Rate for Payer: PHCS Commercial |
$431.52
|
| Rate for Payer: United Healthcare All Payer |
$395.56
|
|
|
GUIDEWIRE .062 DT WS-1606DT
|
Facility
|
OP
|
$449.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$346.12
|
| Rate for Payer: Anthem Medicaid |
$154.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.61
|
| Rate for Payer: Cash Price |
$224.75
|
| Rate for Payer: Cigna Commercial |
$373.08
|
| Rate for Payer: First Health Commercial |
$427.02
|
| Rate for Payer: Humana Commercial |
$382.08
|
| Rate for Payer: Humana KY Medicaid |
$154.58
|
| Rate for Payer: Kentucky WC Medicaid |
$156.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.56
|
| Rate for Payer: Ohio Health Group HMO |
$337.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.34
|
| Rate for Payer: PHCS Commercial |
$431.52
|
| Rate for Payer: United Healthcare All Payer |
$395.56
|
|
|
GUIDEWIRE .062 DT WS-1606DT
|
Facility
|
IP
|
$449.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$346.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.61
|
| Rate for Payer: Cash Price |
$224.75
|
| Rate for Payer: Cigna Commercial |
$373.08
|
| Rate for Payer: First Health Commercial |
$427.02
|
| Rate for Payer: Humana Commercial |
$382.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.56
|
| Rate for Payer: Ohio Health Group HMO |
$337.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.34
|
| Rate for Payer: PHCS Commercial |
$431.52
|
| Rate for Payer: United Healthcare All Payer |
$395.56
|
|
|
GUIDE WIRE .094*8 WS-2408ST
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
GUIDE WIRE .094*8 WS-2408ST
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
GUIDE WIRE .094*8 WS-2408STT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
GUIDE WIRE .094*8 WS-2408STT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
GUIDEWIRE 0.9*80MM
|
Facility
|
IP
|
$539.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$518.26 |
| Rate for Payer: Aetna Commercial |
$415.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.08
|
| Rate for Payer: Cash Price |
$269.92
|
| Rate for Payer: Cigna Commercial |
$448.08
|
| Rate for Payer: First Health Commercial |
$512.86
|
| Rate for Payer: Humana Commercial |
$458.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.07
|
| Rate for Payer: Ohio Health Group HMO |
$404.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.35
|
| Rate for Payer: PHCS Commercial |
$518.26
|
| Rate for Payer: United Healthcare All Payer |
$475.07
|
|
|
GUIDEWIRE 0.9*80MM
|
Facility
|
OP
|
$539.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$518.26 |
| Rate for Payer: Aetna Commercial |
$415.68
|
| Rate for Payer: Anthem Medicaid |
$185.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.08
|
| Rate for Payer: Cash Price |
$269.92
|
| Rate for Payer: Cigna Commercial |
$448.08
|
| Rate for Payer: First Health Commercial |
$512.86
|
| Rate for Payer: Humana Commercial |
$458.87
|
| Rate for Payer: Humana KY Medicaid |
$185.65
|
| Rate for Payer: Kentucky WC Medicaid |
$187.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.07
|
| Rate for Payer: Ohio Health Group HMO |
$404.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.35
|
| Rate for Payer: PHCS Commercial |
$518.26
|
| Rate for Payer: United Healthcare All Payer |
$475.07
|
|
|
GUIDEWIRE 1.0
|
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 1.0
|
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 1.1*15 NITINOL
|
Facility
|
OP
|
$553.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.96 |
| Max. Negotiated Rate |
$531.36 |
| Rate for Payer: Aetna Commercial |
$426.20
|
| Rate for Payer: Anthem Medicaid |
$190.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cigna Commercial |
$459.40
|
| Rate for Payer: First Health Commercial |
$525.82
|
| Rate for Payer: Humana Commercial |
$470.48
|
| Rate for Payer: Humana KY Medicaid |
$190.35
|
| Rate for Payer: Kentucky WC Medicaid |
$192.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.08
|
| Rate for Payer: Ohio Health Group HMO |
$415.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.58
|
| Rate for Payer: PHCS Commercial |
$531.36
|
| Rate for Payer: United Healthcare All Payer |
$487.08
|
|
|
GUIDEWIRE 1.1*15 NITINOL
|
Facility
|
IP
|
$553.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.96 |
| Max. Negotiated Rate |
$531.36 |
| Rate for Payer: Aetna Commercial |
$426.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cigna Commercial |
$459.40
|
| Rate for Payer: First Health Commercial |
$525.82
|
| Rate for Payer: Humana Commercial |
$470.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.08
|
| Rate for Payer: Ohio Health Group HMO |
$415.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.58
|
| Rate for Payer: PHCS Commercial |
$531.36
|
| Rate for Payer: United Healthcare All Payer |
$487.08
|
|
