|
GUIDEWIRE MEIER .035*185CM
|
Facility
|
OP
|
$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 Medicaid |
$386.96
|
| 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: Humana KY Medicaid |
$386.96
|
| Rate for Payer: Kentucky WC Medicaid |
$390.89
|
| 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: Molina Healthcare Medicaid |
$394.72
|
| 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
|
|
|
GUIDEWIRE MEIER .035*260CM
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.46 |
| Max. Negotiated Rate |
$3,496.32 |
| Rate for Payer: Aetna Commercial |
$2,804.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,840.76
|
| Rate for Payer: Cash Price |
$1,821.00
|
| Rate for Payer: Cigna Commercial |
$3,022.86
|
| Rate for Payer: First Health Commercial |
$3,459.90
|
| Rate for Payer: Humana Commercial |
$3,095.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,986.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,687.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,092.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,204.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,731.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,129.02
|
| Rate for Payer: PHCS Commercial |
$3,496.32
|
| Rate for Payer: United Healthcare All Payer |
$3,204.96
|
|
|
GUIDEWIRE MEIER .035*260CM
|
Facility
|
OP
|
$3,642.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.46 |
| Max. Negotiated Rate |
$3,496.32 |
| Rate for Payer: Aetna Commercial |
$2,804.34
|
| Rate for Payer: Anthem Medicaid |
$1,252.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,840.76
|
| Rate for Payer: Cash Price |
$1,821.00
|
| Rate for Payer: Cigna Commercial |
$3,022.86
|
| Rate for Payer: First Health Commercial |
$3,459.90
|
| Rate for Payer: Humana Commercial |
$3,095.70
|
| Rate for Payer: Humana KY Medicaid |
$1,252.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,265.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,986.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,687.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,092.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,277.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,204.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,731.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,129.02
|
| Rate for Payer: PHCS Commercial |
$3,496.32
|
| Rate for Payer: United Healthcare All Payer |
$3,204.96
|
|
|
GUIDEWIRE MICRO .018*130CM SS
|
Facility
|
OP
|
$1,092.52
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$1,048.82 |
| Rate for Payer: Aetna Commercial |
$841.24
|
| Rate for Payer: Anthem Medicaid |
$375.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$852.17
|
| Rate for Payer: Cash Price |
$546.26
|
| Rate for Payer: Cigna Commercial |
$906.79
|
| Rate for Payer: First Health Commercial |
$1,037.89
|
| Rate for Payer: Humana Commercial |
$928.64
|
| Rate for Payer: Humana KY Medicaid |
$375.72
|
| Rate for Payer: Kentucky WC Medicaid |
$379.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$806.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$961.42
|
| Rate for Payer: Ohio Health Group HMO |
$819.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.68
|
| Rate for Payer: PHCS Commercial |
$1,048.82
|
| Rate for Payer: United Healthcare All Payer |
$961.42
|
|
|
GUIDEWIRE MICRO .018*130CM SS
|
Facility
|
IP
|
$1,092.52
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$1,048.82 |
| Rate for Payer: Aetna Commercial |
$841.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$852.17
|
| Rate for Payer: Cash Price |
$546.26
|
| Rate for Payer: Cigna Commercial |
$906.79
|
| Rate for Payer: First Health Commercial |
$1,037.89
|
| Rate for Payer: Humana Commercial |
$928.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$806.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$961.42
|
| Rate for Payer: Ohio Health Group HMO |
$819.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.68
|
| Rate for Payer: PHCS Commercial |
$1,048.82
|
| Rate for Payer: United Healthcare All Payer |
$961.42
|
|
|
GUIDEWIRE MICRO .018*45CM SS
|
Facility
|
IP
|
$510.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.38 |
| Max. Negotiated Rate |
$490.18 |
| Rate for Payer: Aetna Commercial |
$393.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.27
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$423.80
|
| Rate for Payer: First Health Commercial |
$485.07
|
| Rate for Payer: Humana Commercial |
$434.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.33
|
| Rate for Payer: Ohio Health Group HMO |
$382.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.29
|
| Rate for Payer: PHCS Commercial |
$490.18
|
| Rate for Payer: United Healthcare All Payer |
$449.33
|
|
|
GUIDEWIRE MICRO .018*45CM SS
|
Facility
|
OP
|
$510.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.38 |
| Max. Negotiated Rate |
$490.18 |
| Rate for Payer: Aetna Commercial |
$393.16
|
| Rate for Payer: Anthem Medicaid |
$175.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.27
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$423.80
|
| Rate for Payer: First Health Commercial |
$485.07
|
| Rate for Payer: Humana Commercial |
$434.01
|
| Rate for Payer: Humana KY Medicaid |
$175.60
|
| Rate for Payer: Kentucky WC Medicaid |
$177.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.33
|
| Rate for Payer: Ohio Health Group HMO |
$382.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.29
|
| Rate for Payer: PHCS Commercial |
$490.18
|
| Rate for Payer: United Healthcare All Payer |
$449.33
|
|
|
GUIDEWIRE NAVIPRO .025*260 STR
|
Facility
|
IP
|
$1,755.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.19 |
| Max. Negotiated Rate |
$1,685.09 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.13
|
| Rate for Payer: Cash Price |
$877.65
|
| Rate for Payer: Cigna Commercial |
$1,456.90
|
| Rate for Payer: First Health Commercial |
$1,667.54
|
| Rate for Payer: Humana Commercial |
$1,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.14
|
| Rate for Payer: PHCS Commercial |
$1,685.09
|
| Rate for Payer: United Healthcare All Payer |
$1,544.66
|
|
|
GUIDEWIRE NAVIPRO .025*260 STR
|
Facility
|
OP
|
$1,755.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.19 |
| Max. Negotiated Rate |
$1,685.09 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Anthem Medicaid |
$603.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.13
|
| Rate for Payer: Cash Price |
$877.65
|
| Rate for Payer: Cigna Commercial |
$1,456.90
|
| Rate for Payer: First Health Commercial |
$1,667.54
|
| Rate for Payer: Humana Commercial |
$1,492.00
|
| Rate for Payer: Humana KY Medicaid |
$603.65
|
| Rate for Payer: Kentucky WC Medicaid |
$609.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.14
|
| Rate for Payer: PHCS Commercial |
$1,685.09
|
| Rate for Payer: United Healthcare All Payer |
$1,544.66
|
|
|
GUIDEWIRE NITINOL 2.0*20
|
Facility
|
IP
|
$1,146.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.07 |
| Max. Negotiated Rate |
$1,100.83 |
| Rate for Payer: Aetna Commercial |
$882.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$894.43
|
| Rate for Payer: Cash Price |
$573.35
|
| Rate for Payer: Cigna Commercial |
$951.76
|
| Rate for Payer: First Health Commercial |
$1,089.36
|
| Rate for Payer: Humana Commercial |
$974.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$940.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.10
|
| Rate for Payer: Ohio Health Group HMO |
$860.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.48
|
| Rate for Payer: PHCS Commercial |
$1,100.83
|
| Rate for Payer: United Healthcare All Payer |
$1,009.10
|
|
|
GUIDEWIRE NITINOL 2.0*20
|
Facility
|
OP
|
$1,146.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.07 |
| Max. Negotiated Rate |
$1,100.83 |
| Rate for Payer: Aetna Commercial |
$882.96
|
| Rate for Payer: Anthem Medicaid |
$394.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$894.43
|
| Rate for Payer: Cash Price |
$573.35
|
| Rate for Payer: Cigna Commercial |
$951.76
|
| Rate for Payer: First Health Commercial |
$1,089.36
|
| Rate for Payer: Humana Commercial |
$974.70
|
| Rate for Payer: Humana KY Medicaid |
$394.35
|
| Rate for Payer: Kentucky WC Medicaid |
$398.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$940.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$402.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.10
|
| Rate for Payer: Ohio Health Group HMO |
$860.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.48
|
| Rate for Payer: PHCS Commercial |
$1,100.83
|
| Rate for Payer: United Healthcare All Payer |
$1,009.10
|
|
|
GUIDEWIRE NON THRD 1.3*150
|
Facility
|
OP
|
$436.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Humana KY Medicaid |
$150.11
|
| Rate for Payer: Kentucky WC Medicaid |
$151.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
GUIDEWIRE NON THRD 1.3*150
|
Facility
|
IP
|
$436.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
GUIDEWIRE NON-THRDED 2.0M*250M
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
GUIDEWIRE NON-THRDED 2.0M*250M
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
GUIDE WIRE PCL 2.4MM*10
|
Facility
|
IP
|
$1,585.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$1,521.69 |
| Rate for Payer: Aetna Commercial |
$1,220.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,236.37
|
| Rate for Payer: Cash Price |
$792.54
|
| Rate for Payer: Cigna Commercial |
$1,315.62
|
| Rate for Payer: First Health Commercial |
$1,505.84
|
| Rate for Payer: Humana Commercial |
$1,347.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,299.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,169.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$475.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,394.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,188.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.38
|
| Rate for Payer: PHCS Commercial |
$1,521.69
|
| Rate for Payer: United Healthcare All Payer |
$1,394.88
|
|
|
GUIDE WIRE PCL 2.4MM*10
|
Facility
|
OP
|
$1,585.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$1,521.69 |
| Rate for Payer: Aetna Commercial |
$1,220.52
|
| Rate for Payer: Anthem Medicaid |
$545.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,236.37
|
| Rate for Payer: Cash Price |
$792.54
|
| Rate for Payer: Cigna Commercial |
$1,315.62
|
| Rate for Payer: First Health Commercial |
$1,505.84
|
| Rate for Payer: Humana Commercial |
$1,347.33
|
| Rate for Payer: Humana KY Medicaid |
$545.11
|
| Rate for Payer: Kentucky WC Medicaid |
$550.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,299.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,169.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$475.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$556.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,394.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,188.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.38
|
| Rate for Payer: PHCS Commercial |
$1,521.69
|
| Rate for Payer: United Healthcare All Payer |
$1,394.88
|
|
|
GUIDEWIRE PLATINUM .018 ST
|
Facility
|
OP
|
$1,521.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.84 |
| Max. Negotiated Rate |
$1,460.94 |
| Rate for Payer: Aetna Commercial |
$1,171.79
|
| Rate for Payer: Anthem Medicaid |
$523.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.01
|
| Rate for Payer: Cash Price |
$760.90
|
| Rate for Payer: Cigna Commercial |
$1,263.10
|
| Rate for Payer: First Health Commercial |
$1,445.72
|
| Rate for Payer: Humana Commercial |
$1,293.54
|
| Rate for Payer: Humana KY Medicaid |
$523.35
|
| Rate for Payer: Kentucky WC Medicaid |
$528.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,247.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,339.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,141.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.76
|
| Rate for Payer: PHCS Commercial |
$1,460.94
|
| Rate for Payer: United Healthcare All Payer |
$1,339.19
|
|
|
GUIDEWIRE PLATINUM .018 ST
|
Facility
|
IP
|
$1,521.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.84 |
| Max. Negotiated Rate |
$1,460.94 |
| Rate for Payer: Aetna Commercial |
$1,171.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.01
|
| Rate for Payer: Cash Price |
$760.90
|
| Rate for Payer: Cigna Commercial |
$1,263.10
|
| Rate for Payer: First Health Commercial |
$1,445.72
|
| Rate for Payer: Humana Commercial |
$1,293.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,247.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,339.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,141.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.76
|
| Rate for Payer: PHCS Commercial |
$1,460.94
|
| Rate for Payer: United Healthcare All Payer |
$1,339.19
|
|
|
GUIDEWIRE PLATINUM PLUS .025
|
Facility
|
OP
|
$1,570.63
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.18 |
| Max. Negotiated Rate |
$1,507.80 |
| Rate for Payer: Aetna Commercial |
$1,209.39
|
| Rate for Payer: Anthem Medicaid |
$540.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,225.09
|
| Rate for Payer: Cash Price |
$785.32
|
| Rate for Payer: Cigna Commercial |
$1,303.62
|
| Rate for Payer: First Health Commercial |
$1,492.10
|
| Rate for Payer: Humana Commercial |
$1,335.04
|
| Rate for Payer: Humana KY Medicaid |
$540.14
|
| Rate for Payer: Kentucky WC Medicaid |
$545.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,159.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,382.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.90
|
| Rate for Payer: PHCS Commercial |
$1,507.80
|
| Rate for Payer: United Healthcare All Payer |
$1,382.15
|
|
|
GUIDEWIRE PLATINUM PLUS .025
|
Facility
|
IP
|
$1,570.63
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.18 |
| Max. Negotiated Rate |
$1,507.80 |
| Rate for Payer: Aetna Commercial |
$1,209.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,225.09
|
| Rate for Payer: Cash Price |
$785.32
|
| Rate for Payer: Cigna Commercial |
$1,303.62
|
| Rate for Payer: First Health Commercial |
$1,492.10
|
| Rate for Payer: Humana Commercial |
$1,335.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,159.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,382.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.90
|
| Rate for Payer: PHCS Commercial |
$1,507.80
|
| Rate for Payer: United Healthcare All Payer |
$1,382.15
|
|
|
GUIDEWIRE POLARUS 3 20 TR TIP
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$1,482.24 |
| Rate for Payer: Aetna Commercial |
$1,188.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.32
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,281.52
|
| Rate for Payer: First Health Commercial |
$1,466.80
|
| Rate for Payer: Humana Commercial |
$1,312.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.64
|
| Rate for Payer: PHCS Commercial |
$1,482.24
|
| Rate for Payer: United Healthcare All Payer |
$1,358.72
|
|
|
GUIDEWIRE POLARUS 3 20 TR TIP
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$1,482.24 |
| Rate for Payer: Aetna Commercial |
$1,188.88
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.32
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,281.52
|
| Rate for Payer: First Health Commercial |
$1,466.80
|
| Rate for Payer: Humana Commercial |
$1,312.40
|
| Rate for Payer: Humana KY Medicaid |
$530.98
|
| Rate for Payer: Kentucky WC Medicaid |
$536.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.64
|
| Rate for Payer: PHCS Commercial |
$1,482.24
|
| Rate for Payer: United Healthcare All Payer |
$1,358.72
|
|
|
GUIDEWIRE PTFE FX CORE STR .02
|
Facility
|
IP
|
$436.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$418.92 |
| Rate for Payer: Aetna Commercial |
$336.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.37
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cigna Commercial |
$362.19
|
| Rate for Payer: First Health Commercial |
$414.55
|
| Rate for Payer: Humana Commercial |
$370.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.01
|
| Rate for Payer: Ohio Health Group HMO |
$327.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.27
|
| Rate for Payer: PHCS Commercial |
$418.92
|
| Rate for Payer: United Healthcare All Payer |
$384.01
|
|
|
GUIDEWIRE PTFE FX CORE STR .02
|
Facility
|
OP
|
$436.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$418.92 |
| Rate for Payer: Aetna Commercial |
$336.00
|
| Rate for Payer: Anthem Medicaid |
$150.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.37
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cigna Commercial |
$362.19
|
| Rate for Payer: First Health Commercial |
$414.55
|
| Rate for Payer: Humana Commercial |
$370.91
|
| Rate for Payer: Humana KY Medicaid |
$150.07
|
| Rate for Payer: Kentucky WC Medicaid |
$151.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.01
|
| Rate for Payer: Ohio Health Group HMO |
$327.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.27
|
| Rate for Payer: PHCS Commercial |
$418.92
|
| Rate for Payer: United Healthcare All Payer |
$384.01
|
|
