|
GUIDEWIRE 1.1MM AR-8737-41
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Humana KY Medicaid |
$174.70
|
| Rate for Payer: Kentucky WC Medicaid |
$176.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.48
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
GUIDEWIRE 1.1MM AR-8737-41
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.48
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
GUIDEWIRE 1.1MM AR-8933K
|
Facility
|
OP
|
$152.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$146.02 |
| Rate for Payer: Aetna Commercial |
$117.12
|
| Rate for Payer: Anthem Medicaid |
$52.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.64
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna Commercial |
$126.24
|
| Rate for Payer: First Health Commercial |
$144.50
|
| Rate for Payer: Humana Commercial |
$129.28
|
| Rate for Payer: Humana KY Medicaid |
$52.31
|
| Rate for Payer: Kentucky WC Medicaid |
$52.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$53.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.85
|
| Rate for Payer: Ohio Health Group HMO |
$114.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.15
|
| Rate for Payer: PHCS Commercial |
$146.02
|
| Rate for Payer: United Healthcare All Payer |
$133.85
|
|
|
GUIDEWIRE 1.1MM AR-8933K
|
Facility
|
IP
|
$152.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$146.02 |
| Rate for Payer: Aetna Commercial |
$117.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.64
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna Commercial |
$126.24
|
| Rate for Payer: First Health Commercial |
$144.50
|
| Rate for Payer: Humana Commercial |
$129.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.85
|
| Rate for Payer: Ohio Health Group HMO |
$114.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.15
|
| Rate for Payer: PHCS Commercial |
$146.02
|
| Rate for Payer: United Healthcare All Payer |
$133.85
|
|
|
GUIDEWIRE 1.2*150MM SMTH
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
GUIDEWIRE 1.2*150MM SMTH
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
GUIDEWIRE 1.25*150MM THREADED
|
Facility
|
IP
|
$750.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.59 |
| Max. Negotiated Rate |
$720.63 |
| Rate for Payer: Aetna Commercial |
$578.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.51
|
| Rate for Payer: Cash Price |
$375.33
|
| Rate for Payer: Cigna Commercial |
$623.05
|
| Rate for Payer: First Health Commercial |
$713.13
|
| Rate for Payer: Humana Commercial |
$638.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.58
|
| Rate for Payer: Ohio Health Group HMO |
$563.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.70
|
| Rate for Payer: PHCS Commercial |
$720.63
|
| Rate for Payer: United Healthcare All Payer |
$660.58
|
|
|
GUIDEWIRE 1.25*150MM THREADED
|
Facility
|
OP
|
$750.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.59 |
| Max. Negotiated Rate |
$720.63 |
| Rate for Payer: Aetna Commercial |
$578.01
|
| Rate for Payer: Anthem Medicaid |
$258.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.51
|
| Rate for Payer: Cash Price |
$375.33
|
| Rate for Payer: Cigna Commercial |
$623.05
|
| Rate for Payer: First Health Commercial |
$713.13
|
| Rate for Payer: Humana Commercial |
$638.06
|
| Rate for Payer: Humana KY Medicaid |
$258.15
|
| Rate for Payer: Kentucky WC Medicaid |
$260.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.58
|
| Rate for Payer: Ohio Health Group HMO |
$563.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.70
|
| Rate for Payer: PHCS Commercial |
$720.63
|
| Rate for Payer: United Healthcare All Payer |
$660.58
|
|
|
GUIDEWIRE 1.2MM*150MM NON THRE
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
GUIDEWIRE 1.2MM*150MM NON THRE
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem Medicaid |
$375.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Humana KY Medicaid |
$375.13
|
| Rate for Payer: Kentucky WC Medicaid |
$378.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
GUIDE WIRE 1.5MM
|
Facility
|
IP
|
$522.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$501.41 |
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.39
|
| Rate for Payer: Cash Price |
$261.15
|
| Rate for Payer: Cigna Commercial |
$433.51
|
| Rate for Payer: First Health Commercial |
$496.18
|
| Rate for Payer: Humana Commercial |
$443.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.62
|
| Rate for Payer: Ohio Health Group HMO |
$391.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.91
|
| Rate for Payer: PHCS Commercial |
$501.41
|
| Rate for Payer: United Healthcare All Payer |
$459.62
|
|
|
GUIDE WIRE 1.5MM
|
Facility
|
OP
|
$522.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$501.41 |
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Anthem Medicaid |
$179.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.39
|
| Rate for Payer: Cash Price |
$261.15
|
| Rate for Payer: Cigna Commercial |
$433.51
|
| Rate for Payer: First Health Commercial |
$496.18
|
| Rate for Payer: Humana Commercial |
$443.96
|
| Rate for Payer: Humana KY Medicaid |
$179.62
|
| Rate for Payer: Kentucky WC Medicaid |
$181.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$459.62
|
| Rate for Payer: Ohio Health Group HMO |
$391.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.91
|
| Rate for Payer: PHCS Commercial |
$501.41
|
| Rate for Payer: United Healthcare All Payer |
$459.62
|
|
|
GUIDEWIRE 1.6*150MM SMTH
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
GUIDEWIRE 1.6*150MM SMTH
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.45
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
|
|
GUIDEWIRE 1.6MM
|
Facility
|
OP
|
$467.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$448.68 |
| Rate for Payer: Aetna Commercial |
$359.88
|
| Rate for Payer: Anthem Medicaid |
$160.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.56
|
| Rate for Payer: Cash Price |
$233.69
|
| Rate for Payer: Cigna Commercial |
$387.93
|
| Rate for Payer: First Health Commercial |
$444.01
|
| Rate for Payer: Humana Commercial |
$397.27
|
| Rate for Payer: Humana KY Medicaid |
$160.73
|
| Rate for Payer: Kentucky WC Medicaid |
$162.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.29
|
| Rate for Payer: Ohio Health Group HMO |
$350.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.89
|
| Rate for Payer: PHCS Commercial |
$448.68
|
| Rate for Payer: United Healthcare All Payer |
$411.29
|
|
|
GUIDEWIRE 1.6MM
|
Facility
|
IP
|
$467.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$448.68 |
| Rate for Payer: Aetna Commercial |
$359.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.56
|
| Rate for Payer: Cash Price |
$233.69
|
| Rate for Payer: Cigna Commercial |
$387.93
|
| Rate for Payer: First Health Commercial |
$444.01
|
| Rate for Payer: Humana Commercial |
$397.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.29
|
| Rate for Payer: Ohio Health Group HMO |
$350.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.89
|
| Rate for Payer: PHCS Commercial |
$448.68
|
| Rate for Payer: United Healthcare All Payer |
$411.29
|
|
|
GUIDEWIRE 1.6MM DRILL TIP 200M
|
Facility
|
OP
|
$1,554.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$1,492.32 |
| Rate for Payer: Aetna Commercial |
$1,196.96
|
| Rate for Payer: Anthem Medicaid |
$534.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.51
|
| Rate for Payer: Cash Price |
$777.25
|
| Rate for Payer: Cigna Commercial |
$1,290.24
|
| Rate for Payer: First Health Commercial |
$1,476.78
|
| Rate for Payer: Humana Commercial |
$1,321.32
|
| Rate for Payer: Humana KY Medicaid |
$534.59
|
| Rate for Payer: Kentucky WC Medicaid |
$540.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,147.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.90
|
| Rate for Payer: PHCS Commercial |
$1,492.32
|
| Rate for Payer: United Healthcare All Payer |
$1,367.96
|
|
|
GUIDEWIRE 1.6MM DRILL TIP 200M
|
Facility
|
IP
|
$1,554.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$1,492.32 |
| Rate for Payer: Aetna Commercial |
$1,196.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.51
|
| Rate for Payer: Cash Price |
$777.25
|
| Rate for Payer: Cigna Commercial |
$1,290.24
|
| Rate for Payer: First Health Commercial |
$1,476.78
|
| Rate for Payer: Humana Commercial |
$1,321.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,147.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.90
|
| Rate for Payer: PHCS Commercial |
$1,492.32
|
| Rate for Payer: United Healthcare All Payer |
$1,367.96
|
|
|
GUIDEWIRE 1.6MM THREADED
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
GUIDEWIRE 1.6MM THREADED
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
GUIDEWIRE 2.0*150 W/O THRD
|
Facility
|
IP
|
$1,547.22
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.14 |
| Max. Negotiated Rate |
$1,485.33 |
| Rate for Payer: Aetna Commercial |
$1,191.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,206.83
|
| Rate for Payer: Cash Price |
$773.61
|
| Rate for Payer: Cigna Commercial |
$1,284.19
|
| Rate for Payer: First Health Commercial |
$1,469.86
|
| Rate for Payer: Humana Commercial |
$1,315.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,141.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.64
|
| Rate for Payer: PHCS Commercial |
$1,485.33
|
| Rate for Payer: United Healthcare All Payer |
$1,361.55
|
|
|
GUIDEWIRE 2.0*150 W/O THRD
|
Facility
|
OP
|
$1,547.22
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.14 |
| Max. Negotiated Rate |
$1,485.33 |
| Rate for Payer: Aetna Commercial |
$1,191.36
|
| Rate for Payer: Anthem Medicaid |
$532.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,206.83
|
| Rate for Payer: Cash Price |
$773.61
|
| Rate for Payer: Cigna Commercial |
$1,284.19
|
| Rate for Payer: First Health Commercial |
$1,469.86
|
| Rate for Payer: Humana Commercial |
$1,315.14
|
| Rate for Payer: Humana KY Medicaid |
$532.09
|
| Rate for Payer: Kentucky WC Medicaid |
$537.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,141.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.64
|
| Rate for Payer: PHCS Commercial |
$1,485.33
|
| Rate for Payer: United Healthcare All Payer |
$1,361.55
|
|
|
GUIDEWIRE 2.0*240MM
|
Facility
|
OP
|
$772.08
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.37 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Aetna Commercial |
$594.50
|
| Rate for Payer: Anthem Medicaid |
$265.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.22
|
| Rate for Payer: Cash Price |
$386.04
|
| Rate for Payer: Cigna Commercial |
$640.83
|
| Rate for Payer: First Health Commercial |
$733.48
|
| Rate for Payer: Humana Commercial |
$656.27
|
| Rate for Payer: Humana KY Medicaid |
$265.52
|
| Rate for Payer: Kentucky WC Medicaid |
$268.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.43
|
| Rate for Payer: Ohio Health Group HMO |
$579.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.34
|
| Rate for Payer: PHCS Commercial |
$741.20
|
| Rate for Payer: United Healthcare All Payer |
$679.43
|
|
|
GUIDEWIRE 2.0*240MM
|
Facility
|
IP
|
$772.08
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.37 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Aetna Commercial |
$594.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.22
|
| Rate for Payer: Cash Price |
$386.04
|
| Rate for Payer: Cigna Commercial |
$640.83
|
| Rate for Payer: First Health Commercial |
$733.48
|
| Rate for Payer: Humana Commercial |
$656.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.43
|
| Rate for Payer: Ohio Health Group HMO |
$579.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.34
|
| Rate for Payer: PHCS Commercial |
$741.20
|
| Rate for Payer: United Healthcare All Payer |
$679.43
|
|
|
GUIDEWIRE 2.0*6 ST
|
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
|
|
