|
GUIDEWIRE .054*7 ST WS-1407ST
|
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 .062*12 IN
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE .062*12 IN
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE .062*6 IN
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE .062*6 IN
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE 062*6 WS-1607ST
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem Medicaid |
$162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Humana KY Medicaid |
$162.66
|
| Rate for Payer: Kentucky WC Medicaid |
$164.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
GUIDEWIRE 062*6 WS-1607ST
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
GUIDEWIRE .062*7 IN
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE .062*7 IN
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE .062* 9.25MM
|
Facility
|
IP
|
$452.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
GUIDEWIRE .062* 9.25MM
|
Facility
|
OP
|
$452.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem Medicaid |
$155.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Humana KY Medicaid |
$155.70
|
| Rate for Payer: Kentucky WC Medicaid |
$157.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
GUIDEWIRE .062 DT WS-1606DT
|
Facility
|
OP
|
$452.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem Medicaid |
$155.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Humana KY Medicaid |
$155.70
|
| Rate for Payer: Kentucky WC Medicaid |
$157.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
GUIDEWIRE .062 DT WS-1606DT
|
Facility
|
IP
|
$452.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
GUIDE WIRE .094*8 WS-2408ST
|
Facility
|
OP
|
$432.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$415.20 |
| Rate for Payer: Aetna Commercial |
$333.02
|
| Rate for Payer: Anthem Medicaid |
$148.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.35
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna Commercial |
$358.98
|
| Rate for Payer: First Health Commercial |
$410.88
|
| Rate for Payer: Humana Commercial |
$367.62
|
| Rate for Payer: Humana KY Medicaid |
$148.74
|
| Rate for Payer: Kentucky WC Medicaid |
$150.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.60
|
| Rate for Payer: Ohio Health Group HMO |
$324.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.43
|
| Rate for Payer: PHCS Commercial |
$415.20
|
| Rate for Payer: United Healthcare All Payer |
$380.60
|
|
|
GUIDE WIRE .094*8 WS-2408ST
|
Facility
|
IP
|
$432.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$415.20 |
| Rate for Payer: Aetna Commercial |
$333.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.35
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna Commercial |
$358.98
|
| Rate for Payer: First Health Commercial |
$410.88
|
| Rate for Payer: Humana Commercial |
$367.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.60
|
| Rate for Payer: Ohio Health Group HMO |
$324.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.43
|
| Rate for Payer: PHCS Commercial |
$415.20
|
| Rate for Payer: United Healthcare All Payer |
$380.60
|
|
|
GUIDE WIRE .094*8 WS-2408STT
|
Facility
|
IP
|
$432.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$415.20 |
| Rate for Payer: Aetna Commercial |
$333.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.35
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna Commercial |
$358.98
|
| Rate for Payer: First Health Commercial |
$410.88
|
| Rate for Payer: Humana Commercial |
$367.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.60
|
| Rate for Payer: Ohio Health Group HMO |
$324.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.43
|
| Rate for Payer: PHCS Commercial |
$415.20
|
| Rate for Payer: United Healthcare All Payer |
$380.60
|
|
|
GUIDE WIRE .094*8 WS-2408STT
|
Facility
|
OP
|
$432.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$415.20 |
| Rate for Payer: Aetna Commercial |
$333.02
|
| Rate for Payer: Anthem Medicaid |
$148.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.35
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna Commercial |
$358.98
|
| Rate for Payer: First Health Commercial |
$410.88
|
| Rate for Payer: Humana Commercial |
$367.62
|
| Rate for Payer: Humana KY Medicaid |
$148.74
|
| Rate for Payer: Kentucky WC Medicaid |
$150.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.60
|
| Rate for Payer: Ohio Health Group HMO |
$324.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.43
|
| Rate for Payer: PHCS Commercial |
$415.20
|
| Rate for Payer: United Healthcare All Payer |
$380.60
|
|
|
GUIDEWIRE 0.9*80MM
|
Facility
|
IP
|
$546.58
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.97 |
| Max. Negotiated Rate |
$524.72 |
| Rate for Payer: Aetna Commercial |
$420.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.33
|
| Rate for Payer: Cash Price |
$273.29
|
| Rate for Payer: Cigna Commercial |
$453.66
|
| Rate for Payer: First Health Commercial |
$519.25
|
| Rate for Payer: Humana Commercial |
$464.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.99
|
| Rate for Payer: Ohio Health Group HMO |
$409.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.14
|
| Rate for Payer: PHCS Commercial |
$524.72
|
| Rate for Payer: United Healthcare All Payer |
$480.99
|
|
|
GUIDEWIRE 0.9*80MM
|
Facility
|
OP
|
$546.58
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.97 |
| Max. Negotiated Rate |
$524.72 |
| Rate for Payer: Aetna Commercial |
$420.87
|
| Rate for Payer: Anthem Medicaid |
$187.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.33
|
| Rate for Payer: Cash Price |
$273.29
|
| Rate for Payer: Cigna Commercial |
$453.66
|
| Rate for Payer: First Health Commercial |
$519.25
|
| Rate for Payer: Humana Commercial |
$464.59
|
| Rate for Payer: Humana KY Medicaid |
$187.97
|
| Rate for Payer: Kentucky WC Medicaid |
$189.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$480.99
|
| Rate for Payer: Ohio Health Group HMO |
$409.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.14
|
| Rate for Payer: PHCS Commercial |
$524.72
|
| Rate for Payer: United Healthcare All Payer |
$480.99
|
|
|
GUIDEWIRE 1.0
|
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 1.0
|
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 1.1*15 NITINOL
|
Facility
|
OP
|
$560.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$538.32 |
| Rate for Payer: Aetna Commercial |
$431.78
|
| Rate for Payer: Anthem Medicaid |
$192.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.38
|
| Rate for Payer: Cash Price |
$280.38
|
| Rate for Payer: Cigna Commercial |
$465.42
|
| Rate for Payer: First Health Commercial |
$532.71
|
| Rate for Payer: Humana Commercial |
$476.64
|
| Rate for Payer: Humana KY Medicaid |
$192.84
|
| Rate for Payer: Kentucky WC Medicaid |
$194.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.46
|
| Rate for Payer: Ohio Health Group HMO |
$420.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.92
|
| Rate for Payer: PHCS Commercial |
$538.32
|
| Rate for Payer: United Healthcare All Payer |
$493.46
|
|
|
GUIDEWIRE 1.1*15 NITINOL
|
Facility
|
IP
|
$560.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$538.32 |
| Rate for Payer: Aetna Commercial |
$431.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.38
|
| Rate for Payer: Cash Price |
$280.38
|
| Rate for Payer: Cigna Commercial |
$465.42
|
| Rate for Payer: First Health Commercial |
$532.71
|
| Rate for Payer: Humana Commercial |
$476.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.46
|
| Rate for Payer: Ohio Health Group HMO |
$420.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.92
|
| Rate for Payer: PHCS Commercial |
$538.32
|
| Rate for Payer: United Healthcare All Payer |
$493.46
|
|
|
GUIDEWIRE 1.1MM AR-8737-41
|
Facility
|
OP
|
$513.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$492.96 |
| Rate for Payer: Aetna Commercial |
$395.39
|
| Rate for Payer: Anthem Medicaid |
$176.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.53
|
| Rate for Payer: Cash Price |
$256.75
|
| Rate for Payer: Cigna Commercial |
$426.20
|
| Rate for Payer: First Health Commercial |
$487.82
|
| Rate for Payer: Humana Commercial |
$436.48
|
| Rate for Payer: Humana KY Medicaid |
$176.59
|
| Rate for Payer: Kentucky WC Medicaid |
$178.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.88
|
| Rate for Payer: Ohio Health Group HMO |
$385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.31
|
| Rate for Payer: PHCS Commercial |
$492.96
|
| Rate for Payer: United Healthcare All Payer |
$451.88
|
|
|
GUIDEWIRE 1.1MM AR-8737-41
|
Facility
|
IP
|
$513.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$492.96 |
| Rate for Payer: Aetna Commercial |
$395.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.53
|
| Rate for Payer: Cash Price |
$256.75
|
| Rate for Payer: Cigna Commercial |
$426.20
|
| Rate for Payer: First Health Commercial |
$487.82
|
| Rate for Payer: Humana Commercial |
$436.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.88
|
| Rate for Payer: Ohio Health Group HMO |
$385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.31
|
| Rate for Payer: PHCS Commercial |
$492.96
|
| Rate for Payer: United Healthcare All Payer |
$451.88
|
|
