|
GUIDEWIRE FIXED CORE 260CM
|
Facility
|
IP
|
$440.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$422.98 |
| Rate for Payer: Aetna Commercial |
$339.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.67
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cigna Commercial |
$365.70
|
| Rate for Payer: First Health Commercial |
$418.57
|
| Rate for Payer: Humana Commercial |
$374.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$325.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.73
|
| Rate for Payer: Ohio Health Group HMO |
$330.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.59
|
| Rate for Payer: PHCS Commercial |
$422.98
|
| Rate for Payer: United Healthcare All Payer |
$387.73
|
|
|
GUIDEWIRE FIXED CORE 260CM
|
Facility
|
OP
|
$440.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$422.98 |
| Rate for Payer: Aetna Commercial |
$339.26
|
| Rate for Payer: Anthem Medicaid |
$151.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.67
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cigna Commercial |
$365.70
|
| Rate for Payer: First Health Commercial |
$418.57
|
| Rate for Payer: Humana Commercial |
$374.51
|
| Rate for Payer: Humana KY Medicaid |
$151.52
|
| Rate for Payer: Kentucky WC Medicaid |
$153.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$325.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.73
|
| Rate for Payer: Ohio Health Group HMO |
$330.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.59
|
| Rate for Payer: PHCS Commercial |
$422.98
|
| Rate for Payer: United Healthcare All Payer |
$387.73
|
|
|
GUIDEWIRE FLOPPY TIP NITINOL
|
Facility
|
IP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.48
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
GUIDEWIRE FLOPPY TIP NITINOL
|
Facility
|
OP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem Medicaid |
$398.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Humana KY Medicaid |
$398.79
|
| Rate for Payer: Kentucky WC Medicaid |
$402.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.48
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
GUIDE WIRE F/POLARUS 2MM
|
Facility
|
OP
|
$1,082.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.69 |
| Max. Negotiated Rate |
$1,038.91 |
| Rate for Payer: Aetna Commercial |
$833.29
|
| Rate for Payer: Anthem Medicaid |
$372.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.12
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cigna Commercial |
$898.23
|
| Rate for Payer: First Health Commercial |
$1,028.09
|
| Rate for Payer: Humana Commercial |
$919.87
|
| Rate for Payer: Humana KY Medicaid |
$372.17
|
| Rate for Payer: Kentucky WC Medicaid |
$375.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$887.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$798.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$379.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$952.34
|
| Rate for Payer: Ohio Health Group HMO |
$811.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.48
|
| Rate for Payer: PHCS Commercial |
$1,038.91
|
| Rate for Payer: United Healthcare All Payer |
$952.34
|
|
|
GUIDE WIRE F/POLARUS 2MM
|
Facility
|
IP
|
$1,082.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.69 |
| Max. Negotiated Rate |
$1,038.91 |
| Rate for Payer: Aetna Commercial |
$833.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.12
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cigna Commercial |
$898.23
|
| Rate for Payer: First Health Commercial |
$1,028.09
|
| Rate for Payer: Humana Commercial |
$919.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$887.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$798.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$952.34
|
| Rate for Payer: Ohio Health Group HMO |
$811.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.48
|
| Rate for Payer: PHCS Commercial |
$1,038.91
|
| Rate for Payer: United Healthcare All Payer |
$952.34
|
|
|
GUIDEWIRE HALO
|
Facility
|
OP
|
$1,850.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.56 |
| Max. Negotiated Rate |
$1,776.48 |
| Rate for Payer: Aetna Commercial |
$1,424.88
|
| Rate for Payer: Anthem Medicaid |
$636.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.39
|
| Rate for Payer: Cash Price |
$925.25
|
| Rate for Payer: Cigna Commercial |
$1,535.92
|
| Rate for Payer: First Health Commercial |
$1,757.98
|
| Rate for Payer: Humana Commercial |
$1,572.92
|
| Rate for Payer: Humana KY Medicaid |
$636.39
|
| Rate for Payer: Kentucky WC Medicaid |
$642.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.66
|
| Rate for Payer: PHCS Commercial |
$1,776.48
|
| Rate for Payer: United Healthcare All Payer |
$1,628.44
|
|
|
GUIDEWIRE HALO
|
Facility
|
IP
|
$1,850.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.56 |
| Max. Negotiated Rate |
$1,776.48 |
| Rate for Payer: Aetna Commercial |
$1,424.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.39
|
| Rate for Payer: Cash Price |
$925.25
|
| Rate for Payer: Cigna Commercial |
$1,535.92
|
| Rate for Payer: First Health Commercial |
$1,757.98
|
| Rate for Payer: Humana Commercial |
$1,572.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.66
|
| Rate for Payer: PHCS Commercial |
$1,776.48
|
| Rate for Payer: United Healthcare All Payer |
$1,628.44
|
|
|
GUIDEWIRE HYDRA JAGWIRE ST 260
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
GUIDEWIRE HYDRA JAGWIRE ST 260
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
GUIDEWIRE J CVD .035*180CM
|
Facility
|
OP
|
$813.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.77 |
| Max. Negotiated Rate |
$781.08 |
| Rate for Payer: Aetna Commercial |
$626.49
|
| Rate for Payer: Anthem Medicaid |
$279.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.62
|
| Rate for Payer: Cash Price |
$406.81
|
| Rate for Payer: Cigna Commercial |
$675.30
|
| Rate for Payer: First Health Commercial |
$772.94
|
| Rate for Payer: Humana Commercial |
$691.58
|
| Rate for Payer: Humana KY Medicaid |
$279.80
|
| Rate for Payer: Kentucky WC Medicaid |
$282.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$667.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$600.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.99
|
| Rate for Payer: Ohio Health Group HMO |
$610.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.22
|
| Rate for Payer: PHCS Commercial |
$781.08
|
| Rate for Payer: United Healthcare All Payer |
$715.99
|
|
|
GUIDEWIRE J CVD .035*180CM
|
Facility
|
IP
|
$813.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.77 |
| Max. Negotiated Rate |
$781.08 |
| Rate for Payer: Aetna Commercial |
$626.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.62
|
| Rate for Payer: Cash Price |
$406.81
|
| Rate for Payer: Cigna Commercial |
$675.30
|
| Rate for Payer: First Health Commercial |
$772.94
|
| Rate for Payer: Humana Commercial |
$691.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$667.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$600.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.99
|
| Rate for Payer: Ohio Health Group HMO |
$610.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.22
|
| Rate for Payer: PHCS Commercial |
$781.08
|
| Rate for Payer: United Healthcare All Payer |
$715.99
|
|
|
GUIDEWIRE J CVD .035*260CM
|
Facility
|
OP
|
$450.88
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$347.18
|
| Rate for Payer: Anthem Medicaid |
$155.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.69
|
| Rate for Payer: Cash Price |
$225.44
|
| Rate for Payer: Cigna Commercial |
$374.23
|
| Rate for Payer: First Health Commercial |
$428.34
|
| Rate for Payer: Humana Commercial |
$383.25
|
| Rate for Payer: Humana KY Medicaid |
$155.06
|
| Rate for Payer: Kentucky WC Medicaid |
$156.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.77
|
| Rate for Payer: Ohio Health Group HMO |
$338.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.77
|
| Rate for Payer: PHCS Commercial |
$432.84
|
| Rate for Payer: United Healthcare All Payer |
$396.77
|
|
|
GUIDEWIRE J CVD .035*260CM
|
Facility
|
IP
|
$450.88
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$347.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.69
|
| Rate for Payer: Cash Price |
$225.44
|
| Rate for Payer: Cigna Commercial |
$374.23
|
| Rate for Payer: First Health Commercial |
$428.34
|
| Rate for Payer: Humana Commercial |
$383.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.77
|
| Rate for Payer: Ohio Health Group HMO |
$338.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.77
|
| Rate for Payer: PHCS Commercial |
$432.84
|
| Rate for Payer: United Healthcare All Payer |
$396.77
|
|
|
GUIDEWIRE JINDO .022-.035 180C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GUIDEWIRE JINDO .022-.035 180C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GUIDEWIRE 'J' TIP 0.14
|
Facility
|
OP
|
$1,748.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.26 |
| Max. Negotiated Rate |
$1,678.20 |
| Rate for Payer: Aetna Commercial |
$1,346.05
|
| Rate for Payer: Anthem Medicaid |
$601.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,363.53
|
| Rate for Payer: Cash Price |
$874.06
|
| Rate for Payer: Cigna Commercial |
$1,450.94
|
| Rate for Payer: First Health Commercial |
$1,660.71
|
| Rate for Payer: Humana Commercial |
$1,485.90
|
| Rate for Payer: Humana KY Medicaid |
$601.18
|
| Rate for Payer: Kentucky WC Medicaid |
$607.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,433.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,538.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.92
|
| Rate for Payer: PHCS Commercial |
$1,678.20
|
| Rate for Payer: United Healthcare All Payer |
$1,538.35
|
|
|
GUIDEWIRE 'J' TIP 0.14
|
Facility
|
IP
|
$1,748.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.26 |
| Max. Negotiated Rate |
$1,678.20 |
| Rate for Payer: Aetna Commercial |
$1,346.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,363.53
|
| Rate for Payer: Cash Price |
$874.06
|
| Rate for Payer: Cigna Commercial |
$1,450.94
|
| Rate for Payer: First Health Commercial |
$1,660.71
|
| Rate for Payer: Humana Commercial |
$1,485.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,433.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,538.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.92
|
| Rate for Payer: PHCS Commercial |
$1,678.20
|
| Rate for Payer: United Healthcare All Payer |
$1,538.35
|
|
|
GUIDEWIRE MAGIC TORQUE .035*26
|
Facility
|
OP
|
$1,067.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$1,025.01 |
| Rate for Payer: Aetna Commercial |
$822.14
|
| Rate for Payer: Anthem Medicaid |
$367.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$832.82
|
| Rate for Payer: Cash Price |
$533.86
|
| Rate for Payer: Cigna Commercial |
$886.21
|
| Rate for Payer: First Health Commercial |
$1,014.33
|
| Rate for Payer: Humana Commercial |
$907.56
|
| Rate for Payer: Humana KY Medicaid |
$367.19
|
| Rate for Payer: Kentucky WC Medicaid |
$370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$875.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$787.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$374.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$939.59
|
| Rate for Payer: Ohio Health Group HMO |
$800.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.99
|
| Rate for Payer: PHCS Commercial |
$1,025.01
|
| Rate for Payer: United Healthcare All Payer |
$939.59
|
|
|
GUIDEWIRE MAGIC TORQUE .035*26
|
Facility
|
IP
|
$1,067.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$1,025.01 |
| Rate for Payer: Aetna Commercial |
$822.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$832.82
|
| Rate for Payer: Cash Price |
$533.86
|
| Rate for Payer: Cigna Commercial |
$886.21
|
| Rate for Payer: First Health Commercial |
$1,014.33
|
| Rate for Payer: Humana Commercial |
$907.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$875.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$787.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$939.59
|
| Rate for Payer: Ohio Health Group HMO |
$800.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.99
|
| Rate for Payer: PHCS Commercial |
$1,025.01
|
| Rate for Payer: United Healthcare All Payer |
$939.59
|
|
|
GUIDEWIRE MAXXWIRE .035*180 S
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
GUIDEWIRE MAXXWIRE .035*180 S
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
GUIDEWIRE MAXXWIRE .035*180 SS
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
GUIDEWIRE MAXXWIRE .035*180 SS
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
GUIDEWIRE MEIER .035*185CM
|
Facility
|
IP
|
$1,125.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$1,080.19 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.66
|
| Rate for Payer: Cash Price |
$562.60
|
| Rate for Payer: Cigna Commercial |
$933.92
|
| Rate for Payer: First Health Commercial |
$1,068.94
|
| Rate for Payer: Humana Commercial |
$956.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.18
|
| Rate for Payer: Ohio Health Group HMO |
$843.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.81
|
| Rate for Payer: PHCS Commercial |
$1,080.19
|
| Rate for Payer: United Healthcare All Payer |
$990.18
|
|
