|
GUIDEWIRE 2.8MM*300MM THRD
|
Facility
|
OP
|
$1,071.11
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$1,028.27 |
| Rate for Payer: Aetna Commercial |
$824.75
|
| Rate for Payer: Anthem Medicaid |
$368.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.47
|
| Rate for Payer: Cash Price |
$535.55
|
| Rate for Payer: Cigna Commercial |
$889.02
|
| Rate for Payer: First Health Commercial |
$1,017.55
|
| Rate for Payer: Humana Commercial |
$910.44
|
| Rate for Payer: Humana KY Medicaid |
$368.35
|
| Rate for Payer: Kentucky WC Medicaid |
$372.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.58
|
| Rate for Payer: Ohio Health Group HMO |
$803.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.04
|
| Rate for Payer: PHCS Commercial |
$1,028.27
|
| Rate for Payer: United Healthcare All Payer |
$942.58
|
|
|
GUIDEWIRE 2.8MM*300MM THRD
|
Facility
|
IP
|
$1,071.11
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$1,028.27 |
| Rate for Payer: Aetna Commercial |
$824.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.47
|
| Rate for Payer: Cash Price |
$535.55
|
| Rate for Payer: Cigna Commercial |
$889.02
|
| Rate for Payer: First Health Commercial |
$1,017.55
|
| Rate for Payer: Humana Commercial |
$910.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.58
|
| Rate for Payer: Ohio Health Group HMO |
$803.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.04
|
| Rate for Payer: PHCS Commercial |
$1,028.27
|
| Rate for Payer: United Healthcare All Payer |
$942.58
|
|
|
GUIDEWIRE 3.0*28 BALL NOSE
|
Facility
|
IP
|
$1,851.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.68 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Aetna Commercial |
$1,425.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.10
|
| Rate for Payer: Cash Price |
$925.70
|
| Rate for Payer: Cigna Commercial |
$1,536.67
|
| Rate for Payer: First Health Commercial |
$1,758.84
|
| Rate for Payer: Humana Commercial |
$1,573.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.94
|
| Rate for Payer: PHCS Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Payer |
$1,629.24
|
|
|
GUIDEWIRE 3.0*28 BALL NOSE
|
Facility
|
OP
|
$1,851.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.68 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Aetna Commercial |
$1,425.59
|
| Rate for Payer: Anthem Medicaid |
$636.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.10
|
| Rate for Payer: Cash Price |
$925.70
|
| Rate for Payer: Cigna Commercial |
$1,536.67
|
| Rate for Payer: First Health Commercial |
$1,758.84
|
| Rate for Payer: Humana Commercial |
$1,573.70
|
| Rate for Payer: Humana KY Medicaid |
$636.70
|
| Rate for Payer: Kentucky WC Medicaid |
$643.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.94
|
| Rate for Payer: PHCS Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Payer |
$1,629.24
|
|
|
GUIDEWIRE 3.2*230 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 3.2*230 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 3.2*28 DRIVING WIRE
|
Facility
|
IP
|
$1,939.89
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.19 |
| Max. Negotiated Rate |
$1,862.29 |
| Rate for Payer: Aetna Commercial |
$1,493.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.11
|
| Rate for Payer: Cash Price |
$969.94
|
| Rate for Payer: Cigna Commercial |
$1,610.11
|
| Rate for Payer: First Health Commercial |
$1,842.90
|
| Rate for Payer: Humana Commercial |
$1,648.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,707.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,454.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.37
|
| Rate for Payer: PHCS Commercial |
$1,862.29
|
| Rate for Payer: United Healthcare All Payer |
$1,707.10
|
|
|
GUIDEWIRE 3.2*28 DRIVING WIRE
|
Facility
|
OP
|
$1,939.89
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.19 |
| Max. Negotiated Rate |
$1,862.29 |
| Rate for Payer: Aetna Commercial |
$1,493.72
|
| Rate for Payer: Anthem Medicaid |
$667.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.11
|
| Rate for Payer: Cash Price |
$969.94
|
| Rate for Payer: Cigna Commercial |
$1,610.11
|
| Rate for Payer: First Health Commercial |
$1,842.90
|
| Rate for Payer: Humana Commercial |
$1,648.91
|
| Rate for Payer: Humana KY Medicaid |
$667.13
|
| Rate for Payer: Kentucky WC Medicaid |
$673.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,707.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,454.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.37
|
| Rate for Payer: PHCS Commercial |
$1,862.29
|
| Rate for Payer: United Healthcare All Payer |
$1,707.10
|
|
|
GUIDEWIRE 3.2* 320MM
|
Facility
|
IP
|
$1,878.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,803.36 |
| Rate for Payer: Aetna Commercial |
$1,446.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.23
|
| Rate for Payer: Cash Price |
$939.25
|
| Rate for Payer: Cigna Commercial |
$1,559.16
|
| Rate for Payer: First Health Commercial |
$1,784.58
|
| Rate for Payer: Humana Commercial |
$1,596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.34
|
| Rate for Payer: PHCS Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare All Payer |
$1,653.08
|
|
|
GUIDEWIRE 3.2* 320MM
|
Facility
|
OP
|
$1,878.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,803.36 |
| Rate for Payer: Aetna Commercial |
$1,446.44
|
| Rate for Payer: Anthem Medicaid |
$646.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.23
|
| Rate for Payer: Cash Price |
$939.25
|
| Rate for Payer: Cigna Commercial |
$1,559.16
|
| Rate for Payer: First Health Commercial |
$1,784.58
|
| Rate for Payer: Humana Commercial |
$1,596.72
|
| Rate for Payer: Humana KY Medicaid |
$646.02
|
| Rate for Payer: Kentucky WC Medicaid |
$652.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.34
|
| Rate for Payer: PHCS Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare All Payer |
$1,653.08
|
|
|
GUIDE WIRE 3.2*400MM
|
Facility
|
IP
|
$1,722.89
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.98 |
| Max. Negotiated Rate |
$1,653.97 |
| Rate for Payer: Aetna Commercial |
$1,326.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.85
|
| Rate for Payer: Cash Price |
$861.44
|
| Rate for Payer: Cigna Commercial |
$1,430.00
|
| Rate for Payer: First Health Commercial |
$1,636.75
|
| Rate for Payer: Humana Commercial |
$1,464.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.10
|
| Rate for Payer: PHCS Commercial |
$1,653.97
|
| Rate for Payer: United Healthcare All Payer |
$1,516.14
|
|
|
GUIDE WIRE 3.2*400MM
|
Facility
|
OP
|
$1,722.89
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.98 |
| Max. Negotiated Rate |
$1,653.97 |
| Rate for Payer: Aetna Commercial |
$1,326.63
|
| Rate for Payer: Anthem Medicaid |
$592.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.85
|
| Rate for Payer: Cash Price |
$861.44
|
| Rate for Payer: Cigna Commercial |
$1,430.00
|
| Rate for Payer: First Health Commercial |
$1,636.75
|
| Rate for Payer: Humana Commercial |
$1,464.46
|
| Rate for Payer: Humana KY Medicaid |
$592.50
|
| Rate for Payer: Kentucky WC Medicaid |
$598.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.10
|
| Rate for Payer: PHCS Commercial |
$1,653.97
|
| Rate for Payer: United Healthcare All Payer |
$1,516.14
|
|
|
GUIDEWIRE .86 DOUBLE TIPPED
|
Facility
|
OP
|
$741.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.43 |
| Max. Negotiated Rate |
$712.08 |
| Rate for Payer: Aetna Commercial |
$571.15
|
| Rate for Payer: Anthem Medicaid |
$255.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.56
|
| Rate for Payer: Cash Price |
$370.88
|
| Rate for Payer: Cigna Commercial |
$615.65
|
| Rate for Payer: First Health Commercial |
$704.66
|
| Rate for Payer: Humana Commercial |
$630.49
|
| Rate for Payer: Humana KY Medicaid |
$255.09
|
| Rate for Payer: Kentucky WC Medicaid |
$257.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.74
|
| Rate for Payer: Ohio Health Group HMO |
$556.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.94
|
| Rate for Payer: PHCS Commercial |
$712.08
|
| Rate for Payer: United Healthcare All Payer |
$652.74
|
|
|
GUIDEWIRE .86 DOUBLE TIPPED
|
Facility
|
IP
|
$741.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.43 |
| Max. Negotiated Rate |
$712.08 |
| Rate for Payer: Aetna Commercial |
$571.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.56
|
| Rate for Payer: Cash Price |
$370.88
|
| Rate for Payer: Cigna Commercial |
$615.65
|
| Rate for Payer: First Health Commercial |
$704.66
|
| Rate for Payer: Humana Commercial |
$630.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.74
|
| Rate for Payer: Ohio Health Group HMO |
$556.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.94
|
| Rate for Payer: PHCS Commercial |
$712.08
|
| Rate for Payer: United Healthcare All Payer |
$652.74
|
|
|
GUIDEWIRE .86MM AR-8737-39
|
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 .86MM AR-8737-39
|
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 ACUTRAK2 PROBE 1.6MM
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK2 PROBE 1.6MM
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK2 PROBE 2.4MM
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK2 PROBE 2.4MM
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK PARLLEL .035
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
GUIDEWIRE ACUTRAK PARLLEL .035
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
GUIDEWIRE ACUTRK2 9.25*.094 TH
|
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 ACUTRK2 9.25*.094 TH
|
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 AMPLATZ PTFE CTD .03
|
Facility
|
IP
|
$749.47
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.43 |
| Max. Negotiated Rate |
$719.49 |
| Rate for Payer: Aetna Commercial |
$577.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.59
|
| Rate for Payer: Cash Price |
$374.74
|
| Rate for Payer: Cigna Commercial |
$622.06
|
| Rate for Payer: First Health Commercial |
$712.00
|
| Rate for Payer: Humana Commercial |
$637.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.53
|
| Rate for Payer: Ohio Health Group HMO |
$562.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.34
|
| Rate for Payer: PHCS Commercial |
$719.49
|
| Rate for Payer: United Healthcare All Payer |
$659.53
|
|
