|
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
|
|
|
GUIDEWIRE 2.0MM 292.652
|
Facility
|
IP
|
$743.32
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.63 |
| Max. Negotiated Rate |
$713.59 |
| Rate for Payer: Aetna Commercial |
$572.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$579.79
|
| Rate for Payer: Cash Price |
$371.66
|
| Rate for Payer: Cigna Commercial |
$616.96
|
| Rate for Payer: First Health Commercial |
$706.15
|
| Rate for Payer: Humana Commercial |
$631.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$609.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$548.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.12
|
| Rate for Payer: Ohio Health Group HMO |
$557.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.43
|
| Rate for Payer: PHCS Commercial |
$713.59
|
| Rate for Payer: United Healthcare All Payer |
$654.12
|
|
|
GUIDEWIRE 2.0MM 292.652
|
Facility
|
OP
|
$743.32
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.63 |
| Max. Negotiated Rate |
$713.59 |
| Rate for Payer: Aetna Commercial |
$572.36
|
| Rate for Payer: Anthem Medicaid |
$255.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$579.79
|
| Rate for Payer: Cash Price |
$371.66
|
| Rate for Payer: Cigna Commercial |
$616.96
|
| Rate for Payer: First Health Commercial |
$706.15
|
| Rate for Payer: Humana Commercial |
$631.82
|
| Rate for Payer: Humana KY Medicaid |
$255.63
|
| Rate for Payer: Kentucky WC Medicaid |
$258.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$609.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$548.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.12
|
| Rate for Payer: Ohio Health Group HMO |
$557.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.43
|
| Rate for Payer: PHCS Commercial |
$713.59
|
| Rate for Payer: United Healthcare All Payer |
$654.12
|
|
|
GUIDE WIRE 2.0MMX9
|
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
|
|
|
GUIDE WIRE 2.0MMX9
|
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 2.2*800MM
|
Facility
|
OP
|
$1,808.33
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.08 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna Commercial |
$1,392.41
|
| Rate for Payer: Anthem Medicaid |
$621.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.50
|
| Rate for Payer: Cash Price |
$904.16
|
| Rate for Payer: Cigna Commercial |
$1,500.91
|
| Rate for Payer: First Health Commercial |
$1,717.91
|
| Rate for Payer: Humana Commercial |
$1,537.08
|
| Rate for Payer: Humana KY Medicaid |
$621.88
|
| Rate for Payer: Kentucky WC Medicaid |
$628.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.58
|
| Rate for Payer: PHCS Commercial |
$1,736.00
|
| Rate for Payer: United Healthcare All Payer |
$1,591.33
|
|
|
GUIDEWIRE 2.2*800MM
|
Facility
|
IP
|
$1,808.33
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.08 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna Commercial |
$1,392.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.50
|
| Rate for Payer: Cash Price |
$904.16
|
| Rate for Payer: Cigna Commercial |
$1,500.91
|
| Rate for Payer: First Health Commercial |
$1,717.91
|
| Rate for Payer: Humana Commercial |
$1,537.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.58
|
| Rate for Payer: PHCS Commercial |
$1,736.00
|
| Rate for Payer: United Healthcare All Payer |
$1,591.33
|
|
|
GUIDEWIRE 2.2MM*28 IN
|
Facility
|
IP
|
$1,818.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.36 |
| Max. Negotiated Rate |
$1,745.40 |
| Rate for Payer: Aetna Commercial |
$1,399.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.13
|
| Rate for Payer: Cash Price |
$909.06
|
| Rate for Payer: Cigna Commercial |
$1,509.04
|
| Rate for Payer: First Health Commercial |
$1,727.21
|
| Rate for Payer: Humana Commercial |
$1,545.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.62
|
| Rate for Payer: PHCS Commercial |
$1,745.40
|
| Rate for Payer: United Healthcare All Payer |
$1,599.95
|
|
|
GUIDEWIRE 2.2MM*28 IN
|
Facility
|
OP
|
$1,818.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.36 |
| Max. Negotiated Rate |
$1,745.40 |
| Rate for Payer: Aetna Commercial |
$1,399.95
|
| Rate for Payer: Anthem Medicaid |
$625.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.13
|
| Rate for Payer: Cash Price |
$909.06
|
| Rate for Payer: Cigna Commercial |
$1,509.04
|
| Rate for Payer: First Health Commercial |
$1,727.21
|
| Rate for Payer: Humana Commercial |
$1,545.40
|
| Rate for Payer: Humana KY Medicaid |
$625.25
|
| Rate for Payer: Kentucky WC Medicaid |
$631.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,490.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,341.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,599.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.62
|
| Rate for Payer: PHCS Commercial |
$1,745.40
|
| Rate for Payer: United Healthcare All Payer |
$1,599.95
|
|
|
GUIDEWIRE 2.4MM
|
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 2.4MM
|
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 2.4MM*12 AR-8967K-12
|
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 2.4MM*12 AR-8967K-12
|
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 2.4MM 8 AR-8967K
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
GUIDEWIRE 2.4MM 8 AR-8967K
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
GUIDEWIRE 2.4MM 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 2.4MM 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 2.5*800MM
|
Facility
|
OP
|
$1,818.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$1,745.77 |
| Rate for Payer: Aetna Commercial |
$1,400.25
|
| Rate for Payer: Anthem Medicaid |
$625.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.44
|
| Rate for Payer: Cash Price |
$909.26
|
| Rate for Payer: Cigna Commercial |
$1,509.36
|
| Rate for Payer: First Health Commercial |
$1,727.58
|
| Rate for Payer: Humana Commercial |
$1,545.73
|
| Rate for Payer: Humana KY Medicaid |
$625.39
|
| Rate for Payer: Kentucky WC Medicaid |
$631.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,342.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,600.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.74
|
| Rate for Payer: PHCS Commercial |
$1,745.77
|
| Rate for Payer: United Healthcare All Payer |
$1,600.29
|
|
|
GUIDEWIRE 2.5*800MM
|
Facility
|
IP
|
$1,818.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$1,745.77 |
| Rate for Payer: Aetna Commercial |
$1,400.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.44
|
| Rate for Payer: Cash Price |
$909.26
|
| Rate for Payer: Cigna Commercial |
$1,509.36
|
| Rate for Payer: First Health Commercial |
$1,727.58
|
| Rate for Payer: Humana Commercial |
$1,545.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,342.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,600.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,363.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.74
|
| Rate for Payer: PHCS Commercial |
$1,745.77
|
| Rate for Payer: United Healthcare All Payer |
$1,600.29
|
|
|
GUIDE WIRE 2.5MM THRD 230MM
|
Facility
|
IP
|
$1,073.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.56 |
| Max. Negotiated Rate |
$1,030.57 |
| Rate for Payer: Aetna Commercial |
$826.60
|
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$536.76
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$891.01
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: First Health Commercial |
$1,019.83
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana Commercial |
$912.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.25
|
| 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 Benefit Exchange |
$322.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$805.13
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.56
|
| 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: Ohio Health Group PPO SOMC Employees |
$332.79
|
| Rate for Payer: PHCS Commercial |
$1,030.57
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$944.69
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
GUIDE WIRE 2.5MM THRD 230MM
|
Facility
|
OP
|
$1,073.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.56 |
| Max. Negotiated Rate |
$1,030.57 |
| Rate for Payer: Aetna Commercial |
$826.60
|
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$369.18
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$536.76
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: Cigna Commercial |
$891.01
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: First Health Commercial |
$1,019.83
|
| Rate for Payer: Humana Commercial |
$912.48
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$369.18
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Kentucky WC Medicaid |
$372.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.28
|
| 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: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$805.13
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: PHCS Commercial |
$1,030.57
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
| Rate for Payer: United Healthcare All Payer |
$944.69
|
|
|
GUIDEWIRE 2.6MM
|
Facility
|
IP
|
$1,745.57
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.75 |
| Rate for Payer: Aetna Commercial |
$1,344.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.54
|
| Rate for Payer: Cash Price |
$872.78
|
| Rate for Payer: Cigna Commercial |
$1,448.82
|
| Rate for Payer: First Health Commercial |
$1,658.29
|
| Rate for Payer: Humana Commercial |
$1,483.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.13
|
| Rate for Payer: PHCS Commercial |
$1,675.75
|
| Rate for Payer: United Healthcare All Payer |
$1,536.10
|
|
|
GUIDEWIRE 2.6MM
|
Facility
|
OP
|
$1,745.57
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$1,675.75 |
| Rate for Payer: Aetna Commercial |
$1,344.09
|
| Rate for Payer: Anthem Medicaid |
$600.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.54
|
| Rate for Payer: Cash Price |
$872.78
|
| Rate for Payer: Cigna Commercial |
$1,448.82
|
| Rate for Payer: First Health Commercial |
$1,658.29
|
| Rate for Payer: Humana Commercial |
$1,483.73
|
| Rate for Payer: Humana KY Medicaid |
$600.30
|
| Rate for Payer: Kentucky WC Medicaid |
$606.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.13
|
| Rate for Payer: PHCS Commercial |
$1,675.75
|
| Rate for Payer: United Healthcare All Payer |
$1,536.10
|
|
|
GUIDEWIRE 2.8*450MM THREADED
|
Facility
|
IP
|
$1,535.63
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.63 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Aetna Commercial |
$1,182.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.79
|
| Rate for Payer: Cash Price |
$767.82
|
| Rate for Payer: Cigna Commercial |
$1,274.57
|
| Rate for Payer: First Health Commercial |
$1,458.85
|
| Rate for Payer: Humana Commercial |
$1,305.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.05
|
| Rate for Payer: PHCS Commercial |
$1,474.20
|
| Rate for Payer: United Healthcare All Payer |
$1,351.35
|
|
|
GUIDEWIRE 2.8*450MM THREADED
|
Facility
|
OP
|
$1,535.63
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.63 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Aetna Commercial |
$1,182.44
|
| Rate for Payer: Anthem Medicaid |
$528.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.79
|
| Rate for Payer: Cash Price |
$767.82
|
| Rate for Payer: Cigna Commercial |
$1,274.57
|
| Rate for Payer: First Health Commercial |
$1,458.85
|
| Rate for Payer: Humana Commercial |
$1,305.29
|
| Rate for Payer: Humana KY Medicaid |
$528.10
|
| Rate for Payer: Kentucky WC Medicaid |
$533.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.05
|
| Rate for Payer: PHCS Commercial |
$1,474.20
|
| Rate for Payer: United Healthcare All Payer |
$1,351.35
|
|
