|
GUIDWIR ATTAIN HYBRD GWR419588
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
GUIDWIR ATTAIN HYBRD GWR419588
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
GUIDWIR ATTAIN HYBRD GWR419688
|
Facility
|
OP
|
$1,885.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.12 |
| Max. Negotiated Rate |
$1,810.08 |
| Rate for Payer: Aetna Commercial |
$1,451.84
|
| Rate for Payer: Anthem Medicaid |
$648.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.69
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna Commercial |
$1,564.96
|
| Rate for Payer: First Health Commercial |
$1,791.22
|
| Rate for Payer: Humana Commercial |
$1,602.68
|
| Rate for Payer: Humana KY Medicaid |
$648.42
|
| Rate for Payer: Kentucky WC Medicaid |
$655.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,546.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,659.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,414.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.50
|
| Rate for Payer: PHCS Commercial |
$1,810.08
|
| Rate for Payer: United Healthcare All Payer |
$1,659.24
|
|
|
GUIDWIR ATTAIN HYBRD GWR419688
|
Facility
|
IP
|
$1,885.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.12 |
| Max. Negotiated Rate |
$1,810.08 |
| Rate for Payer: Aetna Commercial |
$1,451.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.69
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna Commercial |
$1,564.96
|
| Rate for Payer: First Health Commercial |
$1,791.22
|
| Rate for Payer: Humana Commercial |
$1,602.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,546.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,659.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,414.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.50
|
| Rate for Payer: PHCS Commercial |
$1,810.08
|
| Rate for Payer: United Healthcare All Payer |
$1,659.24
|
|
|
GUIDWIR ATTAIN HYBRID MEDTRONI
|
Facility
|
OP
|
$1,885.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.12 |
| Max. Negotiated Rate |
$1,810.08 |
| Rate for Payer: Aetna Commercial |
$1,451.84
|
| Rate for Payer: Anthem Medicaid |
$648.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.69
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna Commercial |
$1,564.96
|
| Rate for Payer: First Health Commercial |
$1,791.22
|
| Rate for Payer: Humana Commercial |
$1,602.68
|
| Rate for Payer: Humana KY Medicaid |
$648.42
|
| Rate for Payer: Kentucky WC Medicaid |
$655.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,546.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,659.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,414.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.50
|
| Rate for Payer: PHCS Commercial |
$1,810.08
|
| Rate for Payer: United Healthcare All Payer |
$1,659.24
|
|
|
GUIDWIR ATTAIN HYBRID MEDTRONI
|
Facility
|
IP
|
$1,885.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.12 |
| Max. Negotiated Rate |
$1,810.08 |
| Rate for Payer: Aetna Commercial |
$1,451.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.69
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna Commercial |
$1,564.96
|
| Rate for Payer: First Health Commercial |
$1,791.22
|
| Rate for Payer: Humana Commercial |
$1,602.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,546.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,659.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,414.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.50
|
| Rate for Payer: PHCS Commercial |
$1,810.08
|
| Rate for Payer: United Healthcare All Payer |
$1,659.24
|
|
|
GUIDWIR DBL FLEX .025*80CM STR
|
Facility
|
OP
|
$519.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$399.92
|
| Rate for Payer: Anthem Medicaid |
$178.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.12
|
| Rate for Payer: Cash Price |
$259.69
|
| Rate for Payer: Cigna Commercial |
$431.09
|
| Rate for Payer: First Health Commercial |
$493.41
|
| Rate for Payer: Humana Commercial |
$441.47
|
| Rate for Payer: Humana KY Medicaid |
$178.61
|
| Rate for Payer: Kentucky WC Medicaid |
$180.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.05
|
| Rate for Payer: Ohio Health Group HMO |
$389.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.01
|
| Rate for Payer: PHCS Commercial |
$498.60
|
| Rate for Payer: United Healthcare All Payer |
$457.05
|
|
|
GUIDWIR DBL FLEX .025*80CM STR
|
Facility
|
IP
|
$519.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$399.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.12
|
| Rate for Payer: Cash Price |
$259.69
|
| Rate for Payer: Cigna Commercial |
$431.09
|
| Rate for Payer: First Health Commercial |
$493.41
|
| Rate for Payer: Humana Commercial |
$441.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.05
|
| Rate for Payer: Ohio Health Group HMO |
$389.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.01
|
| Rate for Payer: PHCS Commercial |
$498.60
|
| Rate for Payer: United Healthcare All Payer |
$457.05
|
|
|
GUIDWIR DBL FLEX CTD .018*50CM
|
Facility
|
OP
|
$558.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.66 |
| Max. Negotiated Rate |
$536.54 |
| Rate for Payer: Aetna Commercial |
$430.35
|
| Rate for Payer: Anthem Medicaid |
$192.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.94
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cigna Commercial |
$463.89
|
| Rate for Payer: First Health Commercial |
$530.96
|
| Rate for Payer: Humana Commercial |
$475.06
|
| Rate for Payer: Humana KY Medicaid |
$192.21
|
| Rate for Payer: Kentucky WC Medicaid |
$194.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.83
|
| Rate for Payer: Ohio Health Group HMO |
$419.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.26
|
| Rate for Payer: PHCS Commercial |
$536.54
|
| Rate for Payer: United Healthcare All Payer |
$491.83
|
|
|
GUIDWIR DBL FLEX CTD .018*50CM
|
Facility
|
IP
|
$558.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.66 |
| Max. Negotiated Rate |
$536.54 |
| Rate for Payer: Aetna Commercial |
$430.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.94
|
| Rate for Payer: Cash Price |
$279.45
|
| Rate for Payer: Cigna Commercial |
$463.89
|
| Rate for Payer: First Health Commercial |
$530.96
|
| Rate for Payer: Humana Commercial |
$475.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.83
|
| Rate for Payer: Ohio Health Group HMO |
$419.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.26
|
| Rate for Payer: PHCS Commercial |
$536.54
|
| Rate for Payer: United Healthcare All Payer |
$491.83
|
|
|
GUIDWIR DBL FLX HEP CT .018*50
|
Facility
|
IP
|
$767.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$737.01 |
| Rate for Payer: Aetna Commercial |
$591.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.82
|
| Rate for Payer: Cash Price |
$383.86
|
| Rate for Payer: Cigna Commercial |
$637.21
|
| Rate for Payer: First Health Commercial |
$729.33
|
| Rate for Payer: Humana Commercial |
$652.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.59
|
| Rate for Payer: Ohio Health Group HMO |
$575.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.99
|
| Rate for Payer: PHCS Commercial |
$737.01
|
| Rate for Payer: United Healthcare All Payer |
$675.59
|
|
|
GUIDWIR DBL FLX HEP CT .018*50
|
Facility
|
OP
|
$767.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$737.01 |
| Rate for Payer: Aetna Commercial |
$591.14
|
| Rate for Payer: Anthem Medicaid |
$264.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.82
|
| Rate for Payer: Cash Price |
$383.86
|
| Rate for Payer: Cigna Commercial |
$637.21
|
| Rate for Payer: First Health Commercial |
$729.33
|
| Rate for Payer: Humana Commercial |
$652.56
|
| Rate for Payer: Humana KY Medicaid |
$264.02
|
| Rate for Payer: Kentucky WC Medicaid |
$266.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.59
|
| Rate for Payer: Ohio Health Group HMO |
$575.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.99
|
| Rate for Payer: PHCS Commercial |
$737.01
|
| Rate for Payer: United Healthcare All Payer |
$675.59
|
|
|
GUIDWIR FIXED HEP CTD .035*40
|
Facility
|
OP
|
$491.49
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$471.83 |
| Rate for Payer: Aetna Commercial |
$378.45
|
| Rate for Payer: Anthem Medicaid |
$169.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.36
|
| Rate for Payer: Cash Price |
$245.74
|
| Rate for Payer: Cigna Commercial |
$407.94
|
| Rate for Payer: First Health Commercial |
$466.92
|
| Rate for Payer: Humana Commercial |
$417.77
|
| Rate for Payer: Humana KY Medicaid |
$169.02
|
| Rate for Payer: Kentucky WC Medicaid |
$170.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.51
|
| Rate for Payer: Ohio Health Group HMO |
$368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.36
|
| Rate for Payer: PHCS Commercial |
$471.83
|
| Rate for Payer: United Healthcare All Payer |
$432.51
|
|
|
GUIDWIR FIXED HEP CTD .035*40
|
Facility
|
IP
|
$491.49
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$471.83 |
| Rate for Payer: Aetna Commercial |
$378.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.36
|
| Rate for Payer: Cash Price |
$245.74
|
| Rate for Payer: Cigna Commercial |
$407.94
|
| Rate for Payer: First Health Commercial |
$466.92
|
| Rate for Payer: Humana Commercial |
$417.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.51
|
| Rate for Payer: Ohio Health Group HMO |
$368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.36
|
| Rate for Payer: PHCS Commercial |
$471.83
|
| Rate for Payer: United Healthcare All Payer |
$432.51
|
|
|
GUIDWIR FIXED J CURVE .015*30
|
Facility
|
IP
|
$519.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$399.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.12
|
| Rate for Payer: Cash Price |
$259.69
|
| Rate for Payer: Cigna Commercial |
$431.09
|
| Rate for Payer: First Health Commercial |
$493.41
|
| Rate for Payer: Humana Commercial |
$441.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.05
|
| Rate for Payer: Ohio Health Group HMO |
$389.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.01
|
| Rate for Payer: PHCS Commercial |
$498.60
|
| Rate for Payer: United Healthcare All Payer |
$457.05
|
|
|
GUIDWIR FIXED J CURVE .015*30
|
Facility
|
OP
|
$519.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$399.92
|
| Rate for Payer: Anthem Medicaid |
$178.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.12
|
| Rate for Payer: Cash Price |
$259.69
|
| Rate for Payer: Cigna Commercial |
$431.09
|
| Rate for Payer: First Health Commercial |
$493.41
|
| Rate for Payer: Humana Commercial |
$441.47
|
| Rate for Payer: Humana KY Medicaid |
$178.61
|
| Rate for Payer: Kentucky WC Medicaid |
$180.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.05
|
| Rate for Payer: Ohio Health Group HMO |
$389.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.01
|
| Rate for Payer: PHCS Commercial |
$498.60
|
| Rate for Payer: United Healthcare All Payer |
$457.05
|
|
|
GUIDWIR FIXED J CURVE .018*40
|
Facility
|
OP
|
$519.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$399.92
|
| Rate for Payer: Anthem Medicaid |
$178.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.12
|
| Rate for Payer: Cash Price |
$259.69
|
| Rate for Payer: Cigna Commercial |
$431.09
|
| Rate for Payer: First Health Commercial |
$493.41
|
| Rate for Payer: Humana Commercial |
$441.47
|
| Rate for Payer: Humana KY Medicaid |
$178.61
|
| Rate for Payer: Kentucky WC Medicaid |
$180.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.05
|
| Rate for Payer: Ohio Health Group HMO |
$389.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.01
|
| Rate for Payer: PHCS Commercial |
$498.60
|
| Rate for Payer: United Healthcare All Payer |
$457.05
|
|
|
GUIDWIR FIXED J CURVE .018*40
|
Facility
|
IP
|
$519.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$399.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.12
|
| Rate for Payer: Cash Price |
$259.69
|
| Rate for Payer: Cigna Commercial |
$431.09
|
| Rate for Payer: First Health Commercial |
$493.41
|
| Rate for Payer: Humana Commercial |
$441.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$425.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.05
|
| Rate for Payer: Ohio Health Group HMO |
$389.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.01
|
| Rate for Payer: PHCS Commercial |
$498.60
|
| Rate for Payer: United Healthcare All Payer |
$457.05
|
|
|
GUIDWIR FIXED J CURVE .035*50
|
Facility
|
IP
|
$454.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$436.32 |
| Rate for Payer: Aetna Commercial |
$349.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.51
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna Commercial |
$377.24
|
| Rate for Payer: First Health Commercial |
$431.78
|
| Rate for Payer: Humana Commercial |
$386.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.96
|
| Rate for Payer: Ohio Health Group HMO |
$340.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.90
|
| Rate for Payer: PHCS Commercial |
$436.32
|
| Rate for Payer: United Healthcare All Payer |
$399.96
|
|
|
GUIDWIR FIXED J CURVE .035*50
|
Facility
|
OP
|
$454.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$436.32 |
| Rate for Payer: Aetna Commercial |
$349.96
|
| Rate for Payer: Anthem Medicaid |
$156.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.51
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna Commercial |
$377.24
|
| Rate for Payer: First Health Commercial |
$431.78
|
| Rate for Payer: Humana Commercial |
$386.32
|
| Rate for Payer: Humana KY Medicaid |
$156.30
|
| Rate for Payer: Kentucky WC Medicaid |
$157.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.96
|
| Rate for Payer: Ohio Health Group HMO |
$340.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.90
|
| Rate for Payer: PHCS Commercial |
$436.32
|
| Rate for Payer: United Healthcare All Payer |
$399.96
|
|
|
GUIDWIR FX CORE TFE CT .018*15
|
Facility
|
OP
|
$508.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.13 |
| Max. Negotiated Rate |
$488.36 |
| Rate for Payer: Aetna Commercial |
$391.71
|
| Rate for Payer: Anthem Medicaid |
$174.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.79
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$422.23
|
| Rate for Payer: First Health Commercial |
$483.27
|
| Rate for Payer: Humana Commercial |
$432.40
|
| Rate for Payer: Humana KY Medicaid |
$174.95
|
| Rate for Payer: Kentucky WC Medicaid |
$176.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.66
|
| Rate for Payer: Ohio Health Group HMO |
$381.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.70
|
| Rate for Payer: PHCS Commercial |
$488.36
|
| Rate for Payer: United Healthcare All Payer |
$447.66
|
|
|
GUIDWIR FX CORE TFE CT .018*15
|
Facility
|
IP
|
$508.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.13 |
| Max. Negotiated Rate |
$488.36 |
| Rate for Payer: Aetna Commercial |
$391.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.79
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$422.23
|
| Rate for Payer: First Health Commercial |
$483.27
|
| Rate for Payer: Humana Commercial |
$432.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.66
|
| Rate for Payer: Ohio Health Group HMO |
$381.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.70
|
| Rate for Payer: PHCS Commercial |
$488.36
|
| Rate for Payer: United Healthcare All Payer |
$447.66
|
|
|
GUIDWIR HYDROPHILIC .018*260 S
|
Facility
|
IP
|
$1,599.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.91 |
| Max. Negotiated Rate |
$1,535.33 |
| Rate for Payer: Aetna Commercial |
$1,231.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.45
|
| Rate for Payer: Cash Price |
$799.65
|
| Rate for Payer: Cigna Commercial |
$1,327.42
|
| Rate for Payer: First Health Commercial |
$1,519.34
|
| Rate for Payer: Humana Commercial |
$1,359.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,407.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.78
|
| Rate for Payer: PHCS Commercial |
$1,535.33
|
| Rate for Payer: United Healthcare All Payer |
$1,407.38
|
|
|
GUIDWIR HYDROPHILIC .018*260 S
|
Facility
|
OP
|
$1,599.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.91 |
| Max. Negotiated Rate |
$1,535.33 |
| Rate for Payer: Aetna Commercial |
$1,231.46
|
| Rate for Payer: Anthem Medicaid |
$550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.45
|
| Rate for Payer: Cash Price |
$799.65
|
| Rate for Payer: Cigna Commercial |
$1,327.42
|
| Rate for Payer: First Health Commercial |
$1,519.34
|
| Rate for Payer: Humana Commercial |
$1,359.40
|
| Rate for Payer: Humana KY Medicaid |
$550.00
|
| Rate for Payer: Kentucky WC Medicaid |
$555.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,407.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.78
|
| Rate for Payer: PHCS Commercial |
$1,535.33
|
| Rate for Payer: United Healthcare All Payer |
$1,407.38
|
|
|
GUIDWIR MAGIC TORQUE .035*180
|
Facility
|
IP
|
$1,099.76
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$1,055.77 |
| Rate for Payer: Aetna Commercial |
$846.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$857.81
|
| Rate for Payer: Cash Price |
$549.88
|
| Rate for Payer: Cigna Commercial |
$912.80
|
| Rate for Payer: First Health Commercial |
$1,044.77
|
| Rate for Payer: Humana Commercial |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$901.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$967.79
|
| Rate for Payer: Ohio Health Group HMO |
$824.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.93
|
| Rate for Payer: PHCS Commercial |
$1,055.77
|
| Rate for Payer: United Healthcare All Payer |
$967.79
|
|
