|
GUIDEWIRE THREADED 3.2*300MM
|
Facility
|
OP
|
$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 Medicaid |
$263.38
|
| 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: Humana KY Medicaid |
$263.38
|
| Rate for Payer: Kentucky WC Medicaid |
$266.06
|
| 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: Molina Healthcare Medicaid |
$268.67
|
| 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
|
|
|
GUIDEWIRE THREADED 3.2*300MM S
|
Facility
|
IP
|
$1,596.29
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.52 |
| Max. Negotiated Rate |
$1,532.44 |
| Rate for Payer: Aetna Commercial |
$1,229.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.11
|
| Rate for Payer: Cash Price |
$798.14
|
| Rate for Payer: Cigna Commercial |
$1,324.92
|
| Rate for Payer: First Health Commercial |
$1,516.48
|
| Rate for Payer: Humana Commercial |
$1,356.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,308.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.85
|
| Rate for Payer: PHCS Commercial |
$1,532.44
|
| Rate for Payer: United Healthcare All Payer |
$1,404.74
|
|
|
GUIDEWIRE THREADED 3.2*300MM S
|
Facility
|
OP
|
$1,596.29
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.52 |
| Max. Negotiated Rate |
$1,532.44 |
| Rate for Payer: Aetna Commercial |
$1,229.14
|
| Rate for Payer: Anthem Medicaid |
$548.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,245.11
|
| Rate for Payer: Cash Price |
$798.14
|
| Rate for Payer: Cigna Commercial |
$1,324.92
|
| Rate for Payer: First Health Commercial |
$1,516.48
|
| Rate for Payer: Humana Commercial |
$1,356.85
|
| Rate for Payer: Humana KY Medicaid |
$548.96
|
| Rate for Payer: Kentucky WC Medicaid |
$554.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,308.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,178.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$559.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,197.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.85
|
| Rate for Payer: PHCS Commercial |
$1,532.44
|
| Rate for Payer: United Healthcare All Payer |
$1,404.74
|
|
|
GUIDEWIRE THRUWAY JTIP .014*13
|
Facility
|
OP
|
$1,524.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.17 |
| Max. Negotiated Rate |
$1,463.42 |
| Rate for Payer: Aetna Commercial |
$1,173.79
|
| Rate for Payer: Anthem Medicaid |
$524.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.03
|
| Rate for Payer: Cash Price |
$762.20
|
| Rate for Payer: Cigna Commercial |
$1,265.25
|
| Rate for Payer: First Health Commercial |
$1,448.18
|
| Rate for Payer: Humana Commercial |
$1,295.74
|
| Rate for Payer: Humana KY Medicaid |
$524.24
|
| Rate for Payer: Kentucky WC Medicaid |
$529.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,341.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.56
|
| Rate for Payer: PHCS Commercial |
$1,463.42
|
| Rate for Payer: United Healthcare All Payer |
$1,341.47
|
|
|
GUIDEWIRE THRUWAY JTIP .014*13
|
Facility
|
IP
|
$1,524.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.17 |
| Max. Negotiated Rate |
$1,463.42 |
| Rate for Payer: Aetna Commercial |
$1,173.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.03
|
| Rate for Payer: Cash Price |
$762.20
|
| Rate for Payer: Cigna Commercial |
$1,265.25
|
| Rate for Payer: First Health Commercial |
$1,448.18
|
| Rate for Payer: Humana Commercial |
$1,295.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,341.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.56
|
| Rate for Payer: PHCS Commercial |
$1,463.42
|
| Rate for Payer: United Healthcare All Payer |
$1,341.47
|
|
|
GUIDEWIRE THRUWAY STR 0.14*300
|
Facility
|
IP
|
$1,773.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.51 |
| Max. Negotiated Rate |
$1,702.22 |
| Rate for Payer: Aetna Commercial |
$1,365.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.06
|
| Rate for Payer: Cash Price |
$886.58
|
| Rate for Payer: Cigna Commercial |
$1,471.71
|
| Rate for Payer: First Health Commercial |
$1,684.49
|
| Rate for Payer: Humana Commercial |
$1,507.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.68
|
| Rate for Payer: PHCS Commercial |
$1,702.22
|
| Rate for Payer: United Healthcare All Payer |
$1,560.37
|
|
|
GUIDEWIRE THRUWAY STR 0.14*300
|
Facility
|
OP
|
$1,773.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.51 |
| Max. Negotiated Rate |
$1,702.22 |
| Rate for Payer: Aetna Commercial |
$1,365.33
|
| Rate for Payer: Anthem Medicaid |
$609.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.06
|
| Rate for Payer: Cash Price |
$886.58
|
| Rate for Payer: Cigna Commercial |
$1,471.71
|
| Rate for Payer: First Health Commercial |
$1,684.49
|
| Rate for Payer: Humana Commercial |
$1,507.18
|
| Rate for Payer: Humana KY Medicaid |
$609.79
|
| Rate for Payer: Kentucky WC Medicaid |
$615.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.68
|
| Rate for Payer: PHCS Commercial |
$1,702.22
|
| Rate for Payer: United Healthcare All Payer |
$1,560.37
|
|
|
GUIDEWIRE THRUWAY STR .018*130
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
GUIDEWIRE THRUWAY STR .018*130
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
GUIDEWIRE TROCAR TIP 1.35MM
|
Facility
|
IP
|
$501.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$481.44 |
| Rate for Payer: Aetna Commercial |
$386.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
| Rate for Payer: Cash Price |
$250.75
|
| Rate for Payer: Cigna Commercial |
$416.24
|
| Rate for Payer: First Health Commercial |
$476.42
|
| Rate for Payer: Humana Commercial |
$426.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
| Rate for Payer: Ohio Health Group HMO |
$376.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
| Rate for Payer: PHCS Commercial |
$481.44
|
| Rate for Payer: United Healthcare All Payer |
$441.32
|
|
|
GUIDEWIRE TROCAR TIP 1.35MM
|
Facility
|
OP
|
$501.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$481.44 |
| Rate for Payer: Aetna Commercial |
$386.16
|
| Rate for Payer: Anthem Medicaid |
$172.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
| Rate for Payer: Cash Price |
$250.75
|
| Rate for Payer: Cigna Commercial |
$416.24
|
| Rate for Payer: First Health Commercial |
$476.42
|
| Rate for Payer: Humana Commercial |
$426.28
|
| Rate for Payer: Humana KY Medicaid |
$172.47
|
| Rate for Payer: Kentucky WC Medicaid |
$174.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
| Rate for Payer: Ohio Health Group HMO |
$376.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
| Rate for Payer: PHCS Commercial |
$481.44
|
| Rate for Payer: United Healthcare All Payer |
$441.32
|
|
|
GUIDEWIRE TRO TIP 2MM AR-8956K
|
Facility
|
IP
|
$527.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$506.40 |
| Rate for Payer: Aetna Commercial |
$406.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.45
|
| Rate for Payer: Cash Price |
$263.75
|
| Rate for Payer: Cigna Commercial |
$437.82
|
| Rate for Payer: First Health Commercial |
$501.12
|
| Rate for Payer: Humana Commercial |
$448.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.20
|
| Rate for Payer: Ohio Health Group HMO |
$395.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.52
|
| Rate for Payer: PHCS Commercial |
$506.40
|
| Rate for Payer: United Healthcare All Payer |
$464.20
|
|
|
GUIDEWIRE TRO TIP 2MM AR-8956K
|
Facility
|
OP
|
$527.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$506.40 |
| Rate for Payer: Aetna Commercial |
$406.18
|
| Rate for Payer: Anthem Medicaid |
$181.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.45
|
| Rate for Payer: Cash Price |
$263.75
|
| Rate for Payer: Cigna Commercial |
$437.82
|
| Rate for Payer: First Health Commercial |
$501.12
|
| Rate for Payer: Humana Commercial |
$448.38
|
| Rate for Payer: Humana KY Medicaid |
$181.41
|
| Rate for Payer: Kentucky WC Medicaid |
$183.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.20
|
| Rate for Payer: Ohio Health Group HMO |
$395.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.52
|
| Rate for Payer: PHCS Commercial |
$506.40
|
| Rate for Payer: United Healthcare All Payer |
$464.20
|
|
|
GUIDEWIRE VNUS .025*260CM
|
Facility
|
OP
|
$481.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.64 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna Commercial |
$371.04
|
| Rate for Payer: Anthem Medicaid |
$165.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.86
|
| Rate for Payer: Cash Price |
$240.94
|
| Rate for Payer: Cigna Commercial |
$399.95
|
| Rate for Payer: First Health Commercial |
$457.78
|
| Rate for Payer: Humana Commercial |
$409.59
|
| Rate for Payer: Humana KY Medicaid |
$165.72
|
| Rate for Payer: Kentucky WC Medicaid |
$167.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.05
|
| Rate for Payer: Ohio Health Group HMO |
$361.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.38
|
| Rate for Payer: PHCS Commercial |
$462.60
|
| Rate for Payer: United Healthcare All Payer |
$424.05
|
|
|
GUIDEWIRE VNUS .025*260CM
|
Facility
|
IP
|
$481.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.64 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna Commercial |
$371.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.86
|
| Rate for Payer: Cash Price |
$240.94
|
| Rate for Payer: Cigna Commercial |
$399.95
|
| Rate for Payer: First Health Commercial |
$457.78
|
| Rate for Payer: Humana Commercial |
$409.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.05
|
| Rate for Payer: Ohio Health Group HMO |
$361.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.38
|
| Rate for Payer: PHCS Commercial |
$462.60
|
| Rate for Payer: United Healthcare All Payer |
$424.05
|
|
|
GUIDEWIRE W/TROCAR TIP .043
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE W/TROCAR TIP .043
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE W/TROCAR TIP .062
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE W/TROCAR TIP .062
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
GUIDEWIRE W/TRO TIP .078*5.91
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
GUIDEWIRE W/TRO TIP .078*5.91
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
GUIDEWIRE ZMS 2.4MM*100CM
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
GUIDEWIRE ZMS 2.4MM*100CM
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem Medicaid |
$656.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Humana KY Medicaid |
$656.85
|
| Rate for Payer: Kentucky WC Medicaid |
$663.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
GUIDEZILLA 6FR
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
GUIDEZILLA 6FR
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
