|
GUIDEWIRE .028*4 SHORT
|
Facility
|
OP
|
$439.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem Medicaid |
$151.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Humana KY Medicaid |
$151.06
|
| Rate for Payer: Kentucky WC Medicaid |
$152.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
GUIDEWIRE .028*4 SHORT
|
Facility
|
IP
|
$439.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
GUIDE WIRE .028*6
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
GUIDE WIRE .028*6
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$153.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$153.38
|
| Rate for Payer: Kentucky WC Medicaid |
$154.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
GUIDEWIRE .035*5.75 ST WS-0906
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
GUIDEWIRE .035*5.75 ST WS-0906
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$153.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$153.38
|
| Rate for Payer: Kentucky WC Medicaid |
$154.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
GUIDEWIRE .035*5CM*180CM
|
Facility
|
OP
|
$1,155.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.65 |
| Max. Negotiated Rate |
$1,109.28 |
| Rate for Payer: Aetna Commercial |
$889.74
|
| Rate for Payer: Anthem Medicaid |
$397.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.29
|
| Rate for Payer: Cash Price |
$577.75
|
| Rate for Payer: Cigna Commercial |
$959.07
|
| Rate for Payer: First Health Commercial |
$1,097.72
|
| Rate for Payer: Humana Commercial |
$982.17
|
| Rate for Payer: Humana KY Medicaid |
$397.38
|
| Rate for Payer: Kentucky WC Medicaid |
$401.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.84
|
| Rate for Payer: Ohio Health Group HMO |
$866.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$797.29
|
| Rate for Payer: PHCS Commercial |
$1,109.28
|
| Rate for Payer: United Healthcare All Payer |
$1,016.84
|
|
|
GUIDEWIRE .035*5CM*180CM
|
Facility
|
IP
|
$1,155.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.65 |
| Max. Negotiated Rate |
$1,109.28 |
| Rate for Payer: Aetna Commercial |
$889.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.29
|
| Rate for Payer: Cash Price |
$577.75
|
| Rate for Payer: Cigna Commercial |
$959.07
|
| Rate for Payer: First Health Commercial |
$1,097.72
|
| Rate for Payer: Humana Commercial |
$982.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.84
|
| Rate for Payer: Ohio Health Group HMO |
$866.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$797.29
|
| Rate for Payer: PHCS Commercial |
$1,109.28
|
| Rate for Payer: United Healthcare All Payer |
$1,016.84
|
|
|
GUIDEWIRE .035*5CM*260CM
|
Facility
|
OP
|
$1,139.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.95 |
| Max. Negotiated Rate |
$1,094.26 |
| Rate for Payer: Aetna Commercial |
$877.68
|
| Rate for Payer: Anthem Medicaid |
$391.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.08
|
| Rate for Payer: Cash Price |
$569.92
|
| Rate for Payer: Cigna Commercial |
$946.08
|
| Rate for Payer: First Health Commercial |
$1,082.86
|
| Rate for Payer: Humana Commercial |
$968.87
|
| Rate for Payer: Humana KY Medicaid |
$391.99
|
| Rate for Payer: Kentucky WC Medicaid |
$395.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.07
|
| Rate for Payer: Ohio Health Group HMO |
$854.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.50
|
| Rate for Payer: PHCS Commercial |
$1,094.26
|
| Rate for Payer: United Healthcare All Payer |
$1,003.07
|
|
|
GUIDEWIRE .035*5CM*260CM
|
Facility
|
IP
|
$1,139.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.95 |
| Max. Negotiated Rate |
$1,094.26 |
| Rate for Payer: Aetna Commercial |
$877.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.08
|
| Rate for Payer: Cash Price |
$569.92
|
| Rate for Payer: Cigna Commercial |
$946.08
|
| Rate for Payer: First Health Commercial |
$1,082.86
|
| Rate for Payer: Humana Commercial |
$968.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.07
|
| Rate for Payer: Ohio Health Group HMO |
$854.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.50
|
| Rate for Payer: PHCS Commercial |
$1,094.26
|
| Rate for Payer: United Healthcare All Payer |
$1,003.07
|
|
|
GUIDEWIRE .035*6 DBL 80-1525
|
Facility
|
OP
|
$459.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.85 |
| Max. Negotiated Rate |
$441.12 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Anthem Medicaid |
$158.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.41
|
| Rate for Payer: Cash Price |
$229.75
|
| Rate for Payer: Cigna Commercial |
$381.38
|
| Rate for Payer: First Health Commercial |
$436.52
|
| Rate for Payer: Humana Commercial |
$390.57
|
| Rate for Payer: Humana KY Medicaid |
$158.02
|
| Rate for Payer: Kentucky WC Medicaid |
$159.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$376.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$339.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$404.36
|
| Rate for Payer: Ohio Health Group HMO |
$344.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.06
|
| Rate for Payer: PHCS Commercial |
$441.12
|
| Rate for Payer: United Healthcare All Payer |
$404.36
|
|
|
GUIDEWIRE .035*6 DBL 80-1525
|
Facility
|
IP
|
$459.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.85 |
| Max. Negotiated Rate |
$441.12 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$358.41
|
| Rate for Payer: Cash Price |
$229.75
|
| Rate for Payer: Cigna Commercial |
$381.38
|
| Rate for Payer: First Health Commercial |
$436.52
|
| Rate for Payer: Humana Commercial |
$390.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$376.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$339.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$404.36
|
| Rate for Payer: Ohio Health Group HMO |
$344.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.06
|
| Rate for Payer: PHCS Commercial |
$441.12
|
| Rate for Payer: United Healthcare All Payer |
$404.36
|
|
|
GUIDEWIRE .035*6 SNGL 80-1524
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
GUIDEWIRE .035*6 SNGL 80-1524
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem Medicaid |
$287.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Humana KY Medicaid |
$287.16
|
| Rate for Payer: Kentucky WC Medicaid |
$290.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
GUIDEWIRE .035 ACUMED
|
Facility
|
IP
|
$466.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
GUIDEWIRE .035 ACUMED
|
Facility
|
OP
|
$466.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem Medicaid |
$160.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Humana KY Medicaid |
$160.34
|
| Rate for Payer: Kentucky WC Medicaid |
$161.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
GUIDEWIRE .045*5.75 STT
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem Medicaid |
$190.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Humana KY Medicaid |
$190.52
|
| Rate for Payer: Kentucky WC Medicaid |
$192.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
GUIDEWIRE .045*5.75 STT
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
GUIDEWIRE .045*6 ST WS-1106ST
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .045*6 ST WS-1106ST
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .045 ACUMED
|
Facility
|
OP
|
$466.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem Medicaid |
$160.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Humana KY Medicaid |
$160.34
|
| Rate for Payer: Kentucky WC Medicaid |
$161.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
GUIDEWIRE .045 ACUMED
|
Facility
|
IP
|
$466.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
GUIDEWIRE .054*6 WS-1406ST
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .054*6 WS-1406ST
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GUIDEWIRE .054*7 ST WS-1407ST
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$153.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$153.38
|
| Rate for Payer: Kentucky WC Medicaid |
$154.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
