|
GLIDEWIRE .035 260 ST STIFF
|
Facility
|
OP
|
$849.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.78 |
| Max. Negotiated Rate |
$815.28 |
| Rate for Payer: Aetna Commercial |
$653.92
|
| Rate for Payer: Anthem Medicaid |
$292.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.41
|
| Rate for Payer: Cash Price |
$424.62
|
| Rate for Payer: Cigna Commercial |
$704.88
|
| Rate for Payer: First Health Commercial |
$806.79
|
| Rate for Payer: Humana Commercial |
$721.86
|
| Rate for Payer: Humana KY Medicaid |
$292.06
|
| Rate for Payer: Kentucky WC Medicaid |
$295.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.34
|
| Rate for Payer: Ohio Health Group HMO |
$636.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$679.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.98
|
| Rate for Payer: PHCS Commercial |
$815.28
|
| Rate for Payer: United Healthcare All Payer |
$747.34
|
|
|
GLIDEWIRE .035 260 ST STIFF
|
Facility
|
IP
|
$849.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.78 |
| Max. Negotiated Rate |
$815.28 |
| Rate for Payer: Aetna Commercial |
$653.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.41
|
| Rate for Payer: Cash Price |
$424.62
|
| Rate for Payer: Cigna Commercial |
$704.88
|
| Rate for Payer: First Health Commercial |
$806.79
|
| Rate for Payer: Humana Commercial |
$721.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.34
|
| Rate for Payer: Ohio Health Group HMO |
$636.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$679.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.98
|
| Rate for Payer: PHCS Commercial |
$815.28
|
| Rate for Payer: United Healthcare All Payer |
$747.34
|
|
|
GLIDEWIRE ADV. .035 260CM ANGL
|
Facility
|
IP
|
$3,055.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.69 |
| Max. Negotiated Rate |
$2,933.40 |
| Rate for Payer: Aetna Commercial |
$2,352.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,383.38
|
| Rate for Payer: Cash Price |
$1,527.81
|
| Rate for Payer: Cigna Commercial |
$2,536.16
|
| Rate for Payer: First Health Commercial |
$2,902.84
|
| Rate for Payer: Humana Commercial |
$2,597.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,505.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,255.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,688.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,291.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,444.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,658.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.38
|
| Rate for Payer: PHCS Commercial |
$2,933.40
|
| Rate for Payer: United Healthcare All Payer |
$2,688.95
|
|
|
GLIDEWIRE ADV. .035 260CM ANGL
|
Facility
|
OP
|
$3,055.62
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.69 |
| Max. Negotiated Rate |
$2,933.40 |
| Rate for Payer: Aetna Commercial |
$2,352.83
|
| Rate for Payer: Anthem Medicaid |
$1,050.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,383.38
|
| Rate for Payer: Cash Price |
$1,527.81
|
| Rate for Payer: Cigna Commercial |
$2,536.16
|
| Rate for Payer: First Health Commercial |
$2,902.84
|
| Rate for Payer: Humana Commercial |
$2,597.28
|
| Rate for Payer: Humana KY Medicaid |
$1,050.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,061.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,505.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,255.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,071.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,688.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,291.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,444.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,658.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.38
|
| Rate for Payer: PHCS Commercial |
$2,933.40
|
| Rate for Payer: United Healthcare All Payer |
$2,688.95
|
|
|
GLIDEWIRE ADVANTAGE .014
|
Facility
|
OP
|
$3,380.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$3,244.80 |
| Rate for Payer: Aetna Commercial |
$2,602.60
|
| Rate for Payer: Anthem Medicaid |
$1,162.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,636.40
|
| Rate for Payer: Cash Price |
$1,690.00
|
| Rate for Payer: Cigna Commercial |
$2,805.40
|
| Rate for Payer: First Health Commercial |
$3,211.00
|
| Rate for Payer: Humana Commercial |
$2,873.00
|
| Rate for Payer: Humana KY Medicaid |
$1,162.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,174.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,771.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,494.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,185.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,974.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,940.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,332.20
|
| Rate for Payer: PHCS Commercial |
$3,244.80
|
| Rate for Payer: United Healthcare All Payer |
$2,974.40
|
|
|
GLIDEWIRE ADVANTAGE .014
|
Facility
|
IP
|
$3,380.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$3,244.80 |
| Rate for Payer: Aetna Commercial |
$2,602.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,636.40
|
| Rate for Payer: Cash Price |
$1,690.00
|
| Rate for Payer: Cigna Commercial |
$2,805.40
|
| Rate for Payer: First Health Commercial |
$3,211.00
|
| Rate for Payer: Humana Commercial |
$2,873.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,771.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,494.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,974.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,940.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,332.20
|
| Rate for Payer: PHCS Commercial |
$3,244.80
|
| Rate for Payer: United Healthcare All Payer |
$2,974.40
|
|
|
GLIDEWIRE ADVANTAGE .018 300CM
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
GLIDEWIRE ADVANTAGE .018 300CM
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
GLIDEWIRE ANGLED .018*150CM
|
Facility
|
OP
|
$3,007.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.34 |
| Max. Negotiated Rate |
$2,887.50 |
| Rate for Payer: Aetna Commercial |
$2,316.01
|
| Rate for Payer: Anthem Medicaid |
$1,034.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,346.09
|
| Rate for Payer: Cash Price |
$1,503.91
|
| Rate for Payer: Cigna Commercial |
$2,496.48
|
| Rate for Payer: First Health Commercial |
$2,857.42
|
| Rate for Payer: Humana Commercial |
$2,556.64
|
| Rate for Payer: Humana KY Medicaid |
$1,034.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,044.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,466.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,219.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,055.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,646.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,255.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,075.39
|
| Rate for Payer: PHCS Commercial |
$2,887.50
|
| Rate for Payer: United Healthcare All Payer |
$2,646.87
|
|
|
GLIDEWIRE ANGLED .018*150CM
|
Facility
|
IP
|
$3,007.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.34 |
| Max. Negotiated Rate |
$2,887.50 |
| Rate for Payer: Aetna Commercial |
$2,316.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,346.09
|
| Rate for Payer: Cash Price |
$1,503.91
|
| Rate for Payer: Cigna Commercial |
$2,496.48
|
| Rate for Payer: First Health Commercial |
$2,857.42
|
| Rate for Payer: Humana Commercial |
$2,556.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,466.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,219.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,646.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,255.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,075.39
|
| Rate for Payer: PHCS Commercial |
$2,887.50
|
| Rate for Payer: United Healthcare All Payer |
$2,646.87
|
|
|
GLIDEWIRE ANGLED .035*180CM
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem Medicaid |
$392.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Humana KY Medicaid |
$392.05
|
| Rate for Payer: Kentucky WC Medicaid |
$396.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.60
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
GLIDEWIRE ANGLED .035*180CM
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.60
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
GLIDEWIRE GOLD .018
|
Facility
|
IP
|
$1,757.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.37 |
| Max. Negotiated Rate |
$1,687.58 |
| Rate for Payer: Aetna Commercial |
$1,353.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.16
|
| Rate for Payer: Cash Price |
$878.95
|
| Rate for Payer: Cigna Commercial |
$1,459.06
|
| Rate for Payer: First Health Commercial |
$1,670.01
|
| Rate for Payer: Humana Commercial |
$1,494.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,546.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.95
|
| Rate for Payer: PHCS Commercial |
$1,687.58
|
| Rate for Payer: United Healthcare All Payer |
$1,546.95
|
|
|
GLIDEWIRE GOLD .018
|
Facility
|
OP
|
$1,757.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.37 |
| Max. Negotiated Rate |
$1,687.58 |
| Rate for Payer: Aetna Commercial |
$1,353.58
|
| Rate for Payer: Anthem Medicaid |
$604.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,371.16
|
| Rate for Payer: Cash Price |
$878.95
|
| Rate for Payer: Cigna Commercial |
$1,459.06
|
| Rate for Payer: First Health Commercial |
$1,670.01
|
| Rate for Payer: Humana Commercial |
$1,494.21
|
| Rate for Payer: Humana KY Medicaid |
$604.54
|
| Rate for Payer: Kentucky WC Medicaid |
$610.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,441.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,297.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,546.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,318.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,529.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.95
|
| Rate for Payer: PHCS Commercial |
$1,687.58
|
| Rate for Payer: United Healthcare All Payer |
$1,546.95
|
|
|
GLIDEWIRE SS STRAIGHT .035*180
|
Facility
|
IP
|
$783.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.01 |
| Max. Negotiated Rate |
$752.04 |
| Rate for Payer: Aetna Commercial |
$603.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.03
|
| Rate for Payer: Cash Price |
$391.68
|
| Rate for Payer: Cigna Commercial |
$650.20
|
| Rate for Payer: First Health Commercial |
$744.20
|
| Rate for Payer: Humana Commercial |
$665.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.37
|
| Rate for Payer: Ohio Health Group HMO |
$587.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.53
|
| Rate for Payer: PHCS Commercial |
$752.04
|
| Rate for Payer: United Healthcare All Payer |
$689.37
|
|
|
GLIDEWIRE SS STRAIGHT .035*180
|
Facility
|
OP
|
$783.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.01 |
| Max. Negotiated Rate |
$752.04 |
| Rate for Payer: Aetna Commercial |
$603.19
|
| Rate for Payer: Anthem Medicaid |
$269.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.03
|
| Rate for Payer: Cash Price |
$391.68
|
| Rate for Payer: Cigna Commercial |
$650.20
|
| Rate for Payer: First Health Commercial |
$744.20
|
| Rate for Payer: Humana Commercial |
$665.86
|
| Rate for Payer: Humana KY Medicaid |
$269.40
|
| Rate for Payer: Kentucky WC Medicaid |
$272.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$274.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.37
|
| Rate for Payer: Ohio Health Group HMO |
$587.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.53
|
| Rate for Payer: PHCS Commercial |
$752.04
|
| Rate for Payer: United Healthcare All Payer |
$689.37
|
|
|
GLIDEWIRE STD 0.35*180 STRGHT
|
Facility
|
OP
|
$798.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.55 |
| Max. Negotiated Rate |
$766.56 |
| Rate for Payer: Aetna Commercial |
$614.85
|
| Rate for Payer: Anthem Medicaid |
$274.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$622.83
|
| Rate for Payer: Cash Price |
$399.25
|
| Rate for Payer: Cigna Commercial |
$662.75
|
| Rate for Payer: First Health Commercial |
$758.58
|
| Rate for Payer: Humana Commercial |
$678.73
|
| Rate for Payer: Humana KY Medicaid |
$274.60
|
| Rate for Payer: Kentucky WC Medicaid |
$277.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$654.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$702.68
|
| Rate for Payer: Ohio Health Group HMO |
$598.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.97
|
| Rate for Payer: PHCS Commercial |
$766.56
|
| Rate for Payer: United Healthcare All Payer |
$702.68
|
|
|
GLIDEWIRE STD 0.35*180 STRGHT
|
Facility
|
IP
|
$798.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.55 |
| Max. Negotiated Rate |
$766.56 |
| Rate for Payer: Aetna Commercial |
$614.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$622.83
|
| Rate for Payer: Cash Price |
$399.25
|
| Rate for Payer: Cigna Commercial |
$662.75
|
| Rate for Payer: First Health Commercial |
$758.58
|
| Rate for Payer: Humana Commercial |
$678.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$654.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$702.68
|
| Rate for Payer: Ohio Health Group HMO |
$598.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.97
|
| Rate for Payer: PHCS Commercial |
$766.56
|
| Rate for Payer: United Healthcare All Payer |
$702.68
|
|
|
GLIDEWIRE STRAIGHT .035*180CM
|
Facility
|
OP
|
$807.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.13 |
| Max. Negotiated Rate |
$774.82 |
| Rate for Payer: Aetna Commercial |
$621.47
|
| Rate for Payer: Anthem Medicaid |
$277.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.54
|
| Rate for Payer: Cash Price |
$403.55
|
| Rate for Payer: Cigna Commercial |
$669.89
|
| Rate for Payer: First Health Commercial |
$766.75
|
| Rate for Payer: Humana Commercial |
$686.03
|
| Rate for Payer: Humana KY Medicaid |
$277.56
|
| Rate for Payer: Kentucky WC Medicaid |
$280.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$661.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.25
|
| Rate for Payer: Ohio Health Group HMO |
$605.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.90
|
| Rate for Payer: PHCS Commercial |
$774.82
|
| Rate for Payer: United Healthcare All Payer |
$710.25
|
|
|
GLIDEWIRE STRAIGHT .035*180CM
|
Facility
|
IP
|
$807.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.13 |
| Max. Negotiated Rate |
$774.82 |
| Rate for Payer: Aetna Commercial |
$621.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.54
|
| Rate for Payer: Cash Price |
$403.55
|
| Rate for Payer: Cigna Commercial |
$669.89
|
| Rate for Payer: First Health Commercial |
$766.75
|
| Rate for Payer: Humana Commercial |
$686.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$661.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.25
|
| Rate for Payer: Ohio Health Group HMO |
$605.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.90
|
| Rate for Payer: PHCS Commercial |
$774.82
|
| Rate for Payer: United Healthcare All Payer |
$710.25
|
|
|
GLOBAL ADVANTAGE CTA HD 44*18
|
Facility
|
OP
|
$12,189.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.89 |
| Max. Negotiated Rate |
$11,702.05 |
| Rate for Payer: Aetna Commercial |
$9,386.02
|
| Rate for Payer: Anthem Medicaid |
$4,192.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,507.92
|
| Rate for Payer: Cash Price |
$6,094.82
|
| Rate for Payer: Cigna Commercial |
$10,117.40
|
| Rate for Payer: First Health Commercial |
$11,580.16
|
| Rate for Payer: Humana Commercial |
$10,361.19
|
| Rate for Payer: Humana KY Medicaid |
$4,192.02
|
| Rate for Payer: Kentucky WC Medicaid |
$4,234.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,995.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,995.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,656.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,276.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,726.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,142.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,751.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,604.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,410.85
|
| Rate for Payer: PHCS Commercial |
$11,702.05
|
| Rate for Payer: United Healthcare All Payer |
$10,726.88
|
|
|
GLOBAL ADVANTAGE CTA HD 44*18
|
Facility
|
IP
|
$12,189.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.89 |
| Max. Negotiated Rate |
$11,702.05 |
| Rate for Payer: Aetna Commercial |
$9,386.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,507.92
|
| Rate for Payer: Cash Price |
$6,094.82
|
| Rate for Payer: Cigna Commercial |
$10,117.40
|
| Rate for Payer: First Health Commercial |
$11,580.16
|
| Rate for Payer: Humana Commercial |
$10,361.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,995.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,995.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,656.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,726.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,142.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,751.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,604.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,410.85
|
| Rate for Payer: PHCS Commercial |
$11,702.05
|
| Rate for Payer: United Healthcare All Payer |
$10,726.88
|
|
|
GLOBAL ADVANTAGE CTA HD 44*23
|
Facility
|
OP
|
$13,078.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,923.61 |
| Max. Negotiated Rate |
$12,555.55 |
| Rate for Payer: Aetna Commercial |
$10,070.60
|
| Rate for Payer: Anthem Medicaid |
$4,497.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,201.39
|
| Rate for Payer: Cash Price |
$6,539.35
|
| Rate for Payer: Cigna Commercial |
$10,855.32
|
| Rate for Payer: First Health Commercial |
$12,424.76
|
| Rate for Payer: Humana Commercial |
$11,116.90
|
| Rate for Payer: Humana KY Medicaid |
$4,497.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,543.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,724.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,652.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,923.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,588.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,509.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,809.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,462.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,024.30
|
| Rate for Payer: PHCS Commercial |
$12,555.55
|
| Rate for Payer: United Healthcare All Payer |
$11,509.26
|
|
|
GLOBAL ADVANTAGE CTA HD 44*23
|
Facility
|
IP
|
$13,078.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,923.61 |
| Max. Negotiated Rate |
$12,555.55 |
| Rate for Payer: Aetna Commercial |
$10,070.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,201.39
|
| Rate for Payer: Cash Price |
$6,539.35
|
| Rate for Payer: Cigna Commercial |
$10,855.32
|
| Rate for Payer: First Health Commercial |
$12,424.76
|
| Rate for Payer: Humana Commercial |
$11,116.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,724.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,652.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,923.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,509.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,809.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,462.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,024.30
|
| Rate for Payer: PHCS Commercial |
$12,555.55
|
| Rate for Payer: United Healthcare All Payer |
$11,509.26
|
|
|
GLOBAL ADVANTAGE CTA HD 48*18
|
Facility
|
IP
|
$18,595.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,578.64 |
| Max. Negotiated Rate |
$17,851.64 |
| Rate for Payer: Aetna Commercial |
$14,318.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,504.46
|
| Rate for Payer: Cash Price |
$9,297.73
|
| Rate for Payer: Cigna Commercial |
$15,434.23
|
| Rate for Payer: First Health Commercial |
$17,665.69
|
| Rate for Payer: Humana Commercial |
$15,806.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,248.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,723.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,578.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,946.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,876.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,830.87
|
| Rate for Payer: PHCS Commercial |
$17,851.64
|
| Rate for Payer: United Healthcare All Payer |
$16,364.00
|
|
