|
GUIDEWIRE AMPLATZ PTFE CTD .03
|
Facility
|
OP
|
$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 Medicaid |
$257.74
|
| 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: Humana KY Medicaid |
$257.74
|
| Rate for Payer: Kentucky WC Medicaid |
$260.37
|
| 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: Molina Healthcare Medicaid |
$262.91
|
| 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
|
|
|
GUIDEWIRE AMPLATZ STR 0.35*72C
|
Facility
|
OP
|
$540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.18
|
| Rate for Payer: Anthem Medicaid |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.42
|
| Rate for Payer: Humana KY Medicaid |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$187.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.56
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
GUIDEWIRE AMPLATZ STR 0.35*72C
|
Facility
|
IP
|
$540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.56
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
GUIDEWIRE ANIS III 2.0*150MM
|
Facility
|
OP
|
$1,096.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.49 |
| Max. Negotiated Rate |
$1,052.25 |
| Rate for Payer: Aetna Commercial |
$843.99
|
| Rate for Payer: Anthem Medicaid |
$376.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$854.95
|
| Rate for Payer: Cash Price |
$548.04
|
| Rate for Payer: Cigna Commercial |
$909.75
|
| Rate for Payer: First Health Commercial |
$1,041.29
|
| Rate for Payer: Humana Commercial |
$931.68
|
| Rate for Payer: Humana KY Medicaid |
$376.95
|
| Rate for Payer: Kentucky WC Medicaid |
$380.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$898.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$808.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$964.56
|
| Rate for Payer: Ohio Health Group HMO |
$822.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.79
|
| Rate for Payer: PHCS Commercial |
$1,052.25
|
| Rate for Payer: United Healthcare All Payer |
$964.56
|
|
|
GUIDEWIRE ANIS III 2.0*150MM
|
Facility
|
IP
|
$1,096.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.49 |
| Max. Negotiated Rate |
$1,052.25 |
| Rate for Payer: Aetna Commercial |
$843.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$854.95
|
| Rate for Payer: Cash Price |
$548.04
|
| Rate for Payer: Cigna Commercial |
$909.75
|
| Rate for Payer: First Health Commercial |
$1,041.29
|
| Rate for Payer: Humana Commercial |
$931.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$898.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$808.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$964.56
|
| Rate for Payer: Ohio Health Group HMO |
$822.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.79
|
| Rate for Payer: PHCS Commercial |
$1,052.25
|
| Rate for Payer: United Healthcare All Payer |
$964.56
|
|
|
GUIDEWIRE BENTSON PTFE CTD .03
|
Facility
|
IP
|
$1,124.77
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.22 |
| Max. Negotiated Rate |
$1,079.78 |
| Rate for Payer: Aetna Commercial |
$866.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.32
|
| Rate for Payer: Cash Price |
$562.38
|
| Rate for Payer: Cigna Commercial |
$933.56
|
| Rate for Payer: First Health Commercial |
$1,068.53
|
| Rate for Payer: Humana Commercial |
$956.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.80
|
| Rate for Payer: Ohio Health Group HMO |
$843.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.68
|
| Rate for Payer: PHCS Commercial |
$1,079.78
|
| Rate for Payer: United Healthcare All Payer |
$989.80
|
|
|
GUIDEWIRE BENTSON PTFE CTD .03
|
Facility
|
OP
|
$1,124.77
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.22 |
| Max. Negotiated Rate |
$1,079.78 |
| Rate for Payer: Aetna Commercial |
$866.07
|
| Rate for Payer: Anthem Medicaid |
$386.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.32
|
| Rate for Payer: Cash Price |
$562.38
|
| Rate for Payer: Cigna Commercial |
$933.56
|
| Rate for Payer: First Health Commercial |
$1,068.53
|
| Rate for Payer: Humana Commercial |
$956.05
|
| Rate for Payer: Humana KY Medicaid |
$386.81
|
| Rate for Payer: Kentucky WC Medicaid |
$390.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.80
|
| Rate for Payer: Ohio Health Group HMO |
$843.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.68
|
| Rate for Payer: PHCS Commercial |
$1,079.78
|
| Rate for Payer: United Healthcare All Payer |
$989.80
|
|
|
GUIDEWIRE CONTROL .018*8*200
|
Facility
|
IP
|
$1,572.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.39 |
| Max. Negotiated Rate |
$1,509.35 |
| Rate for Payer: Aetna Commercial |
$1,210.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.35
|
| Rate for Payer: Cash Price |
$786.12
|
| Rate for Payer: Cigna Commercial |
$1,304.96
|
| Rate for Payer: First Health Commercial |
$1,493.63
|
| Rate for Payer: Humana Commercial |
$1,336.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.39
|
| Rate for Payer: PHCS Commercial |
$1,509.35
|
| Rate for Payer: United Healthcare All Payer |
$1,383.57
|
|
|
GUIDEWIRE CONTROL .018*8*200
|
Facility
|
OP
|
$1,572.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.39 |
| Max. Negotiated Rate |
$1,509.35 |
| Rate for Payer: Aetna Commercial |
$1,210.62
|
| Rate for Payer: Anthem Medicaid |
$540.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.35
|
| Rate for Payer: Cash Price |
$786.12
|
| Rate for Payer: Cigna Commercial |
$1,304.96
|
| Rate for Payer: First Health Commercial |
$1,493.63
|
| Rate for Payer: Humana Commercial |
$1,336.40
|
| Rate for Payer: Humana KY Medicaid |
$540.69
|
| Rate for Payer: Kentucky WC Medicaid |
$546.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.39
|
| Rate for Payer: PHCS Commercial |
$1,509.35
|
| Rate for Payer: United Healthcare All Payer |
$1,383.57
|
|
|
GUIDEWIRE CONTROL .018*8*300
|
Facility
|
IP
|
$1,588.52
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.51 |
| Max. Negotiated Rate |
$1,524.98 |
| Rate for Payer: Aetna Commercial |
$1,223.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,239.05
|
| Rate for Payer: Cash Price |
$794.26
|
| Rate for Payer: Cigna Commercial |
$1,318.47
|
| Rate for Payer: First Health Commercial |
$1,509.09
|
| Rate for Payer: Humana Commercial |
$1,350.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,302.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,172.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,397.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,191.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.44
|
| Rate for Payer: PHCS Commercial |
$1,524.98
|
| Rate for Payer: United Healthcare All Payer |
$1,397.90
|
|
|
GUIDEWIRE CONTROL .018*8*300
|
Facility
|
OP
|
$1,588.52
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.51 |
| Max. Negotiated Rate |
$1,524.98 |
| Rate for Payer: Aetna Commercial |
$1,223.16
|
| Rate for Payer: Anthem Medicaid |
$546.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,239.05
|
| Rate for Payer: Cash Price |
$794.26
|
| Rate for Payer: Cigna Commercial |
$1,318.47
|
| Rate for Payer: First Health Commercial |
$1,509.09
|
| Rate for Payer: Humana Commercial |
$1,350.24
|
| Rate for Payer: Humana KY Medicaid |
$546.29
|
| Rate for Payer: Kentucky WC Medicaid |
$551.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,302.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,172.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,397.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,191.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.44
|
| Rate for Payer: PHCS Commercial |
$1,524.98
|
| Rate for Payer: United Healthcare All Payer |
$1,397.90
|
|
|
GUIDEWIRE COUGAR XT .014*190CM
|
Facility
|
OP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem Medicaid |
$638.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Humana KY Medicaid |
$638.79
|
| Rate for Payer: Kentucky WC Medicaid |
$645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
GUIDEWIRE COUGAR XT .014*190CM
|
Facility
|
IP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
GUIDEWIRE COUGAR XT .014*300CM
|
Facility
|
IP
|
$1,138.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.95 |
| Max. Negotiated Rate |
$1,092.58 |
| Rate for Payer: Aetna Commercial |
$876.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.72
|
| Rate for Payer: Cash Price |
$569.05
|
| Rate for Payer: Cigna Commercial |
$944.62
|
| Rate for Payer: First Health Commercial |
$1,081.20
|
| Rate for Payer: Humana Commercial |
$967.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.53
|
| Rate for Payer: Ohio Health Group HMO |
$853.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.81
|
| Rate for Payer: PHCS Commercial |
$1,092.58
|
| Rate for Payer: United Healthcare All Payer |
$1,001.53
|
|
|
GUIDEWIRE COUGAR XT .014*300CM
|
Facility
|
OP
|
$1,138.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.95 |
| Max. Negotiated Rate |
$1,092.58 |
| Rate for Payer: Aetna Commercial |
$876.34
|
| Rate for Payer: Anthem Medicaid |
$391.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.72
|
| Rate for Payer: Cash Price |
$569.05
|
| Rate for Payer: Cigna Commercial |
$944.62
|
| Rate for Payer: First Health Commercial |
$1,081.20
|
| Rate for Payer: Humana Commercial |
$967.38
|
| Rate for Payer: Humana KY Medicaid |
$391.39
|
| Rate for Payer: Kentucky WC Medicaid |
$395.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.53
|
| Rate for Payer: Ohio Health Group HMO |
$853.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.81
|
| Rate for Payer: PHCS Commercial |
$1,092.58
|
| Rate for Payer: United Healthcare All Payer |
$1,001.53
|
|
|
GUIDEWIRE C-TSCF-35-125-SPENCE
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE C-TSCF-35-125-SPENCE
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE DBL TIPPED 1.1MM
|
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 DBL TIPPED 1.1MM
|
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 E-Z GLIDER ANG .025
|
Facility
|
OP
|
$764.67
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$734.08 |
| Rate for Payer: Aetna Commercial |
$588.80
|
| Rate for Payer: Anthem Medicaid |
$262.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.44
|
| Rate for Payer: Cash Price |
$382.34
|
| Rate for Payer: Cigna Commercial |
$634.68
|
| Rate for Payer: First Health Commercial |
$726.44
|
| Rate for Payer: Humana Commercial |
$649.97
|
| Rate for Payer: Humana KY Medicaid |
$262.97
|
| Rate for Payer: Kentucky WC Medicaid |
$265.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$672.91
|
| Rate for Payer: Ohio Health Group HMO |
$573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.05
|
| Rate for Payer: PHCS Commercial |
$734.08
|
| Rate for Payer: United Healthcare All Payer |
$672.91
|
|
|
GUIDEWIRE E-Z GLIDER ANG .025
|
Facility
|
IP
|
$764.67
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$734.08 |
| Rate for Payer: Aetna Commercial |
$588.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.44
|
| Rate for Payer: Cash Price |
$382.34
|
| Rate for Payer: Cigna Commercial |
$634.68
|
| Rate for Payer: First Health Commercial |
$726.44
|
| Rate for Payer: Humana Commercial |
$649.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$672.91
|
| Rate for Payer: Ohio Health Group HMO |
$573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.05
|
| Rate for Payer: PHCS Commercial |
$734.08
|
| Rate for Payer: United Healthcare All Payer |
$672.91
|
|
|
GUIDEWIRE E-Z GLIDER STR .025
|
Facility
|
IP
|
$559.21
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$536.84 |
| Rate for Payer: Aetna Commercial |
$430.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.18
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$464.14
|
| Rate for Payer: First Health Commercial |
$531.25
|
| Rate for Payer: Humana Commercial |
$475.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.10
|
| Rate for Payer: Ohio Health Group HMO |
$419.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.36
|
| Rate for Payer: PHCS Commercial |
$536.84
|
| Rate for Payer: United Healthcare All Payer |
$492.10
|
|
|
GUIDEWIRE E-Z GLIDER STR .025
|
Facility
|
OP
|
$559.21
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$536.84 |
| Rate for Payer: Aetna Commercial |
$430.59
|
| Rate for Payer: Anthem Medicaid |
$192.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.18
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$464.14
|
| Rate for Payer: First Health Commercial |
$531.25
|
| Rate for Payer: Humana Commercial |
$475.33
|
| Rate for Payer: Humana KY Medicaid |
$192.31
|
| Rate for Payer: Kentucky WC Medicaid |
$194.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.10
|
| Rate for Payer: Ohio Health Group HMO |
$419.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.36
|
| Rate for Payer: PHCS Commercial |
$536.84
|
| Rate for Payer: United Healthcare All Payer |
$492.10
|
|
|
GUIDEWIRE FIXED CORE .015*15CM
|
Facility
|
IP
|
$469.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.02 |
| Max. Negotiated Rate |
$450.61 |
| Rate for Payer: Aetna Commercial |
$361.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.12
|
| Rate for Payer: Cash Price |
$234.70
|
| Rate for Payer: Cigna Commercial |
$389.59
|
| Rate for Payer: First Health Commercial |
$445.92
|
| Rate for Payer: Humana Commercial |
$398.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.06
|
| Rate for Payer: Ohio Health Group HMO |
$352.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.51
|
| Rate for Payer: PHCS Commercial |
$450.61
|
| Rate for Payer: United Healthcare All Payer |
$413.06
|
|
|
GUIDEWIRE FIXED CORE .015*15CM
|
Facility
|
OP
|
$469.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.02 |
| Max. Negotiated Rate |
$450.61 |
| Rate for Payer: Aetna Commercial |
$361.43
|
| Rate for Payer: Anthem Medicaid |
$161.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.12
|
| Rate for Payer: Cash Price |
$234.70
|
| Rate for Payer: Cigna Commercial |
$389.59
|
| Rate for Payer: First Health Commercial |
$445.92
|
| Rate for Payer: Humana Commercial |
$398.98
|
| Rate for Payer: Humana KY Medicaid |
$161.42
|
| Rate for Payer: Kentucky WC Medicaid |
$163.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.06
|
| Rate for Payer: Ohio Health Group HMO |
$352.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.51
|
| Rate for Payer: PHCS Commercial |
$450.61
|
| Rate for Payer: United Healthcare All Payer |
$413.06
|
|
