|
GUIDEWIRE ROSENN .035*180*3CM
|
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 ROSENN .035*180*3CM
|
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 SHT TAPER .018*190
|
Facility
|
IP
|
$1,728.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,659.46 |
| Rate for Payer: Aetna Commercial |
$1,331.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.31
|
| Rate for Payer: Cash Price |
$864.30
|
| Rate for Payer: Cigna Commercial |
$1,434.74
|
| Rate for Payer: First Health Commercial |
$1,642.17
|
| Rate for Payer: Humana Commercial |
$1,469.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,417.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.87
|
| Rate for Payer: PHCS Commercial |
$1,659.46
|
| Rate for Payer: United Healthcare All Payer |
$1,521.17
|
|
|
GUIDEWIRE SHT TAPER .018*190
|
Facility
|
OP
|
$1,728.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,659.46 |
| Rate for Payer: Aetna Commercial |
$1,331.02
|
| Rate for Payer: Anthem Medicaid |
$594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.31
|
| Rate for Payer: Cash Price |
$864.30
|
| Rate for Payer: Cigna Commercial |
$1,434.74
|
| Rate for Payer: First Health Commercial |
$1,642.17
|
| Rate for Payer: Humana Commercial |
$1,469.31
|
| Rate for Payer: Humana KY Medicaid |
$594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$600.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,417.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.87
|
| Rate for Payer: PHCS Commercial |
$1,659.46
|
| Rate for Payer: United Healthcare All Payer |
$1,521.17
|
|
|
GUIDEWIRE SMTH TIP/3.2M*98C
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
GUIDEWIRE SMTH TIP/3.2M*98C
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
GUIDE WIRE ST .059*5
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem Medicaid |
$152.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Humana KY Medicaid |
$152.35
|
| Rate for Payer: Kentucky WC Medicaid |
$153.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
GUIDE WIRE ST .059*5
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.59 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.33
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
GUIDE WIRE ST .062*9
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
GUIDE WIRE ST .062*9
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
GUIDEWIRE ST. 150CM
|
Facility
|
OP
|
$482.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$462.89 |
| Rate for Payer: Aetna Commercial |
$371.28
|
| Rate for Payer: Anthem Medicaid |
$165.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.10
|
| Rate for Payer: Cash Price |
$241.09
|
| Rate for Payer: Cigna Commercial |
$400.21
|
| Rate for Payer: First Health Commercial |
$458.07
|
| Rate for Payer: Humana Commercial |
$409.85
|
| Rate for Payer: Humana KY Medicaid |
$165.82
|
| Rate for Payer: Kentucky WC Medicaid |
$167.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.32
|
| Rate for Payer: Ohio Health Group HMO |
$361.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.48
|
| Rate for Payer: PHCS Commercial |
$462.89
|
| Rate for Payer: United Healthcare All Payer |
$424.32
|
|
|
GUIDEWIRE ST. 150CM
|
Facility
|
IP
|
$482.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$462.89 |
| Rate for Payer: Aetna Commercial |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.10
|
| Rate for Payer: Cash Price |
$241.09
|
| Rate for Payer: Cigna Commercial |
$400.21
|
| Rate for Payer: First Health Commercial |
$458.07
|
| Rate for Payer: Humana Commercial |
$409.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.32
|
| Rate for Payer: Ohio Health Group HMO |
$361.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.48
|
| Rate for Payer: PHCS Commercial |
$462.89
|
| Rate for Payer: United Healthcare All Payer |
$424.32
|
|
|
GUIDE WIRE ST 2.0*9
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Humana KY Medicaid |
$165.76
|
| Rate for Payer: Kentucky WC Medicaid |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
GUIDE WIRE ST 2.0*9
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
GUIDEWIRE STR FIXD COR .025*15
|
Facility
|
IP
|
$158.17
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$151.84 |
| Rate for Payer: Aetna Commercial |
$121.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.37
|
| Rate for Payer: Cash Price |
$79.08
|
| Rate for Payer: Cigna Commercial |
$131.28
|
| Rate for Payer: First Health Commercial |
$150.26
|
| Rate for Payer: Humana Commercial |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.19
|
| Rate for Payer: Ohio Health Group HMO |
$118.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.03
|
| Rate for Payer: PHCS Commercial |
$151.84
|
| Rate for Payer: United Healthcare All Payer |
$139.19
|
|
|
GUIDEWIRE STR FIXD COR .025*15
|
Facility
|
OP
|
$158.17
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$151.84 |
| Rate for Payer: Aetna Commercial |
$121.79
|
| Rate for Payer: Anthem Medicaid |
$54.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.37
|
| Rate for Payer: Cash Price |
$79.08
|
| Rate for Payer: Cigna Commercial |
$131.28
|
| Rate for Payer: First Health Commercial |
$150.26
|
| Rate for Payer: Humana Commercial |
$134.44
|
| Rate for Payer: Humana KY Medicaid |
$54.39
|
| Rate for Payer: Kentucky WC Medicaid |
$54.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.19
|
| Rate for Payer: Ohio Health Group HMO |
$118.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.03
|
| Rate for Payer: PHCS Commercial |
$151.84
|
| Rate for Payer: United Healthcare All Payer |
$139.19
|
|
|
GUIDEWIRE SUREGLIDE ANG .035
|
Facility
|
OP
|
$786.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$755.38 |
| Rate for Payer: Aetna Commercial |
$605.87
|
| Rate for Payer: Anthem Medicaid |
$270.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.74
|
| Rate for Payer: Cash Price |
$393.42
|
| Rate for Payer: Cigna Commercial |
$653.09
|
| Rate for Payer: First Health Commercial |
$747.51
|
| Rate for Payer: Humana Commercial |
$668.82
|
| Rate for Payer: Humana KY Medicaid |
$270.60
|
| Rate for Payer: Kentucky WC Medicaid |
$273.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$692.43
|
| Rate for Payer: Ohio Health Group HMO |
$590.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.92
|
| Rate for Payer: PHCS Commercial |
$755.38
|
| Rate for Payer: United Healthcare All Payer |
$692.43
|
|
|
GUIDEWIRE SUREGLIDE ANG .035
|
Facility
|
IP
|
$786.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$755.38 |
| Rate for Payer: Aetna Commercial |
$605.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.74
|
| Rate for Payer: Cash Price |
$393.42
|
| Rate for Payer: Cigna Commercial |
$653.09
|
| Rate for Payer: First Health Commercial |
$747.51
|
| Rate for Payer: Humana Commercial |
$668.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$692.43
|
| Rate for Payer: Ohio Health Group HMO |
$590.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.92
|
| Rate for Payer: PHCS Commercial |
$755.38
|
| Rate for Payer: United Healthcare All Payer |
$692.43
|
|
|
GUIDEWIRE T2 BALL TIP 3*800MM
|
Facility
|
IP
|
$1,832.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.17 |
| Max. Negotiated Rate |
$1,758.81 |
| Rate for Payer: Aetna Commercial |
$1,410.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.03
|
| Rate for Payer: Cash Price |
$916.04
|
| Rate for Payer: Cigna Commercial |
$1,520.63
|
| Rate for Payer: First Health Commercial |
$1,740.49
|
| Rate for Payer: Humana Commercial |
$1,557.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.95
|
| Rate for Payer: PHCS Commercial |
$1,758.81
|
| Rate for Payer: United Healthcare All Payer |
$1,612.24
|
|
|
GUIDEWIRE T2 BALL TIP 3*800MM
|
Facility
|
OP
|
$1,832.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.17 |
| Max. Negotiated Rate |
$1,758.81 |
| Rate for Payer: Aetna Commercial |
$1,410.71
|
| Rate for Payer: Anthem Medicaid |
$630.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.03
|
| Rate for Payer: Cash Price |
$916.04
|
| Rate for Payer: Cigna Commercial |
$1,520.63
|
| Rate for Payer: First Health Commercial |
$1,740.49
|
| Rate for Payer: Humana Commercial |
$1,557.28
|
| Rate for Payer: Humana KY Medicaid |
$630.06
|
| Rate for Payer: Kentucky WC Medicaid |
$636.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.95
|
| Rate for Payer: PHCS Commercial |
$1,758.81
|
| Rate for Payer: United Healthcare All Payer |
$1,612.24
|
|
|
GUIDEWIRE THRD 3.2MM TIP
|
Facility
|
OP
|
$1,156.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.33 |
| Max. Negotiated Rate |
$1,110.12 |
| Rate for Payer: Aetna Commercial |
$890.41
|
| Rate for Payer: Anthem Medicaid |
$397.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.98
|
| Rate for Payer: Cash Price |
$578.19
|
| Rate for Payer: Cigna Commercial |
$959.80
|
| Rate for Payer: First Health Commercial |
$1,098.56
|
| Rate for Payer: Humana Commercial |
$982.92
|
| Rate for Payer: Humana KY Medicaid |
$397.68
|
| Rate for Payer: Kentucky WC Medicaid |
$401.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,017.61
|
| Rate for Payer: Ohio Health Group HMO |
$867.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.48
|
| Rate for Payer: PHCS Commercial |
$1,110.12
|
| Rate for Payer: United Healthcare All Payer |
$1,017.61
|
|
|
GUIDEWIRE THRD 3.2MM TIP
|
Facility
|
IP
|
$1,156.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.33 |
| Max. Negotiated Rate |
$1,110.12 |
| Rate for Payer: Aetna Commercial |
$890.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.98
|
| Rate for Payer: Cash Price |
$578.19
|
| Rate for Payer: Cigna Commercial |
$959.80
|
| Rate for Payer: First Health Commercial |
$1,098.56
|
| Rate for Payer: Humana Commercial |
$982.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,017.61
|
| Rate for Payer: Ohio Health Group HMO |
$867.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.48
|
| Rate for Payer: PHCS Commercial |
$1,110.12
|
| Rate for Payer: United Healthcare All Payer |
$1,017.61
|
|
|
GUIDEWIRE THREADED 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
|
|
|
GUIDEWIRE THREADED 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 THREADED 3.2*300MM
|
Facility
|
IP
|
$765.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$735.24 |
| Rate for Payer: Aetna Commercial |
$589.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$597.38
|
| Rate for Payer: Cash Price |
$382.94
|
| Rate for Payer: Cigna Commercial |
$635.67
|
| Rate for Payer: First Health Commercial |
$727.58
|
| Rate for Payer: Humana Commercial |
$650.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$565.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.97
|
| Rate for Payer: Ohio Health Group HMO |
$574.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.42
|
| Rate for Payer: PHCS Commercial |
$735.24
|
| Rate for Payer: United Healthcare All Payer |
$673.97
|
|
