|
GUIDEWIRE 1.1MM AR-8933K
|
Facility
|
IP
|
$155.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$119.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.09
|
| Rate for Payer: Cash Price |
$77.62
|
| Rate for Payer: Cigna Commercial |
$128.86
|
| Rate for Payer: First Health Commercial |
$147.49
|
| Rate for Payer: Humana Commercial |
$131.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.62
|
| Rate for Payer: Ohio Health Group HMO |
$116.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.12
|
| Rate for Payer: PHCS Commercial |
$149.04
|
| Rate for Payer: United Healthcare All Payer |
$136.62
|
|
|
GUIDEWIRE 1.1MM AR-8933K
|
Facility
|
OP
|
$155.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$119.54
|
| Rate for Payer: Anthem Medicaid |
$53.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.09
|
| Rate for Payer: Cash Price |
$77.62
|
| Rate for Payer: Cigna Commercial |
$128.86
|
| Rate for Payer: First Health Commercial |
$147.49
|
| Rate for Payer: Humana Commercial |
$131.96
|
| Rate for Payer: Humana KY Medicaid |
$53.39
|
| Rate for Payer: Kentucky WC Medicaid |
$53.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.62
|
| Rate for Payer: Ohio Health Group HMO |
$116.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.12
|
| Rate for Payer: PHCS Commercial |
$149.04
|
| Rate for Payer: United Healthcare All Payer |
$136.62
|
|
|
GUIDEWIRE 1.2*150MM SMTH
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
GUIDEWIRE 1.2*150MM SMTH
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
GUIDEWIRE 1.25*150MM THREADED
|
Facility
|
IP
|
$767.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.22 |
| Max. Negotiated Rate |
$736.70 |
| Rate for Payer: Aetna Commercial |
$590.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.57
|
| Rate for Payer: Cash Price |
$383.70
|
| Rate for Payer: Cigna Commercial |
$636.94
|
| Rate for Payer: First Health Commercial |
$729.03
|
| Rate for Payer: Humana Commercial |
$652.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.31
|
| Rate for Payer: Ohio Health Group HMO |
$575.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.51
|
| Rate for Payer: PHCS Commercial |
$736.70
|
| Rate for Payer: United Healthcare All Payer |
$675.31
|
|
|
GUIDEWIRE 1.25*150MM THREADED
|
Facility
|
OP
|
$767.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.22 |
| Max. Negotiated Rate |
$736.70 |
| Rate for Payer: Aetna Commercial |
$590.90
|
| Rate for Payer: Anthem Medicaid |
$263.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$598.57
|
| Rate for Payer: Cash Price |
$383.70
|
| Rate for Payer: Cigna Commercial |
$636.94
|
| Rate for Payer: First Health Commercial |
$729.03
|
| Rate for Payer: Humana Commercial |
$652.29
|
| Rate for Payer: Humana KY Medicaid |
$263.91
|
| Rate for Payer: Kentucky WC Medicaid |
$266.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.31
|
| Rate for Payer: Ohio Health Group HMO |
$575.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.51
|
| Rate for Payer: PHCS Commercial |
$736.70
|
| Rate for Payer: United Healthcare All Payer |
$675.31
|
|
|
GUIDEWIRE 1.2MM*150MM NON THRE
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
GUIDEWIRE 1.2MM*150MM NON THRE
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
GUIDEWIRE 1.35MM DUAL TROCAR
|
Facility
|
OP
|
$815.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.57 |
| Max. Negotiated Rate |
$782.64 |
| Rate for Payer: Aetna Commercial |
$627.74
|
| Rate for Payer: Anthem Medicaid |
$280.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.89
|
| Rate for Payer: Cash Price |
$407.62
|
| Rate for Payer: Cigna Commercial |
$676.66
|
| Rate for Payer: First Health Commercial |
$774.49
|
| Rate for Payer: Humana Commercial |
$692.96
|
| Rate for Payer: Humana KY Medicaid |
$280.36
|
| Rate for Payer: Kentucky WC Medicaid |
$283.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.42
|
| Rate for Payer: Ohio Health Group HMO |
$611.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.52
|
| Rate for Payer: PHCS Commercial |
$782.64
|
| Rate for Payer: United Healthcare All Payer |
$717.42
|
|
|
GUIDEWIRE 1.35MM DUAL TROCAR
|
Facility
|
IP
|
$815.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.57 |
| Max. Negotiated Rate |
$782.64 |
| Rate for Payer: Aetna Commercial |
$627.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.89
|
| Rate for Payer: Cash Price |
$407.62
|
| Rate for Payer: Cigna Commercial |
$676.66
|
| Rate for Payer: First Health Commercial |
$774.49
|
| Rate for Payer: Humana Commercial |
$692.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.42
|
| Rate for Payer: Ohio Health Group HMO |
$611.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.52
|
| Rate for Payer: PHCS Commercial |
$782.64
|
| Rate for Payer: United Healthcare All Payer |
$717.42
|
|
|
GUIDE WIRE 1.5MM
|
Facility
|
OP
|
$528.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.50 |
| Max. Negotiated Rate |
$507.22 |
| Rate for Payer: Aetna Commercial |
$406.83
|
| Rate for Payer: Anthem Medicaid |
$181.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$412.11
|
| Rate for Payer: Cash Price |
$264.18
|
| Rate for Payer: Cigna Commercial |
$438.53
|
| Rate for Payer: First Health Commercial |
$501.93
|
| Rate for Payer: Humana Commercial |
$449.10
|
| Rate for Payer: Humana KY Medicaid |
$181.70
|
| Rate for Payer: Kentucky WC Medicaid |
$183.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$433.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.95
|
| Rate for Payer: Ohio Health Group HMO |
$396.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.56
|
| Rate for Payer: PHCS Commercial |
$507.22
|
| Rate for Payer: United Healthcare All Payer |
$464.95
|
|
|
GUIDE WIRE 1.5MM
|
Facility
|
IP
|
$528.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.50 |
| Max. Negotiated Rate |
$507.22 |
| Rate for Payer: Aetna Commercial |
$406.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$412.11
|
| Rate for Payer: Cash Price |
$264.18
|
| Rate for Payer: Cigna Commercial |
$438.53
|
| Rate for Payer: First Health Commercial |
$501.93
|
| Rate for Payer: Humana Commercial |
$449.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$433.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.95
|
| Rate for Payer: Ohio Health Group HMO |
$396.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.56
|
| Rate for Payer: PHCS Commercial |
$507.22
|
| Rate for Payer: United Healthcare All Payer |
$464.95
|
|
|
GUIDEWIRE 1.6*150MM SMTH
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
GUIDEWIRE 1.6*150MM SMTH
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
GUIDEWIRE 1.6MM
|
Facility
|
OP
|
$471.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Aetna Commercial |
$362.91
|
| Rate for Payer: Anthem Medicaid |
$162.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.62
|
| Rate for Payer: Cash Price |
$235.66
|
| Rate for Payer: Cigna Commercial |
$391.19
|
| Rate for Payer: First Health Commercial |
$447.74
|
| Rate for Payer: Humana Commercial |
$400.61
|
| Rate for Payer: Humana KY Medicaid |
$162.08
|
| Rate for Payer: Kentucky WC Medicaid |
$163.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.75
|
| Rate for Payer: Ohio Health Group HMO |
$353.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.20
|
| Rate for Payer: PHCS Commercial |
$452.46
|
| Rate for Payer: United Healthcare All Payer |
$414.75
|
|
|
GUIDEWIRE 1.6MM
|
Facility
|
IP
|
$471.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Aetna Commercial |
$362.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.62
|
| Rate for Payer: Cash Price |
$235.66
|
| Rate for Payer: Cigna Commercial |
$391.19
|
| Rate for Payer: First Health Commercial |
$447.74
|
| Rate for Payer: Humana Commercial |
$400.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.75
|
| Rate for Payer: Ohio Health Group HMO |
$353.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.20
|
| Rate for Payer: PHCS Commercial |
$452.46
|
| Rate for Payer: United Healthcare All Payer |
$414.75
|
|
|
GUIDEWIRE 1.6MM DRILL TIP 200M
|
Facility
|
OP
|
$782.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$751.30 |
| Rate for Payer: Aetna Commercial |
$602.60
|
| Rate for Payer: Anthem Medicaid |
$269.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.43
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Cigna Commercial |
$649.56
|
| Rate for Payer: First Health Commercial |
$743.47
|
| Rate for Payer: Humana Commercial |
$665.21
|
| Rate for Payer: Humana KY Medicaid |
$269.14
|
| Rate for Payer: Kentucky WC Medicaid |
$271.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$641.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$274.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$688.69
|
| Rate for Payer: Ohio Health Group HMO |
$586.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.99
|
| Rate for Payer: PHCS Commercial |
$751.30
|
| Rate for Payer: United Healthcare All Payer |
$688.69
|
|
|
GUIDEWIRE 1.6MM DRILL TIP 200M
|
Facility
|
IP
|
$782.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$751.30 |
| Rate for Payer: Aetna Commercial |
$602.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.43
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Cigna Commercial |
$649.56
|
| Rate for Payer: First Health Commercial |
$743.47
|
| Rate for Payer: Humana Commercial |
$665.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$641.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$688.69
|
| Rate for Payer: Ohio Health Group HMO |
$586.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.99
|
| Rate for Payer: PHCS Commercial |
$751.30
|
| Rate for Payer: United Healthcare All Payer |
$688.69
|
|
|
GUIDEWIRE 1.6MM THREADED
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
GUIDEWIRE 1.6MM THREADED
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
GUIDEWIRE 2.0*150 W/O THRD
|
Facility
|
OP
|
$1,522.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.81 |
| Max. Negotiated Rate |
$1,461.79 |
| Rate for Payer: Aetna Commercial |
$1,172.48
|
| Rate for Payer: Anthem Medicaid |
$523.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.71
|
| Rate for Payer: Cash Price |
$761.35
|
| Rate for Payer: Cigna Commercial |
$1,263.84
|
| Rate for Payer: First Health Commercial |
$1,446.57
|
| Rate for Payer: Humana Commercial |
$1,294.30
|
| Rate for Payer: Humana KY Medicaid |
$523.66
|
| Rate for Payer: Kentucky WC Medicaid |
$528.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,339.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,324.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.66
|
| Rate for Payer: PHCS Commercial |
$1,461.79
|
| Rate for Payer: United Healthcare All Payer |
$1,339.98
|
|
|
GUIDEWIRE 2.0*150 W/O THRD
|
Facility
|
IP
|
$1,522.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.81 |
| Max. Negotiated Rate |
$1,461.79 |
| Rate for Payer: Aetna Commercial |
$1,172.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.71
|
| Rate for Payer: Cash Price |
$761.35
|
| Rate for Payer: Cigna Commercial |
$1,263.84
|
| Rate for Payer: First Health Commercial |
$1,446.57
|
| Rate for Payer: Humana Commercial |
$1,294.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,339.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,324.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.66
|
| Rate for Payer: PHCS Commercial |
$1,461.79
|
| Rate for Payer: United Healthcare All Payer |
$1,339.98
|
|
|
GUIDEWIRE 2.0*240MM
|
Facility
|
IP
|
$791.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.36 |
| Max. Negotiated Rate |
$759.55 |
| Rate for Payer: Aetna Commercial |
$609.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$617.14
|
| Rate for Payer: Cash Price |
$395.60
|
| Rate for Payer: Cigna Commercial |
$656.70
|
| Rate for Payer: First Health Commercial |
$751.64
|
| Rate for Payer: Humana Commercial |
$672.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.26
|
| Rate for Payer: Ohio Health Group HMO |
$593.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.93
|
| Rate for Payer: PHCS Commercial |
$759.55
|
| Rate for Payer: United Healthcare All Payer |
$696.26
|
|
|
GUIDEWIRE 2.0*240MM
|
Facility
|
OP
|
$791.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.36 |
| Max. Negotiated Rate |
$759.55 |
| Rate for Payer: Aetna Commercial |
$609.22
|
| Rate for Payer: Anthem Medicaid |
$272.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$617.14
|
| Rate for Payer: Cash Price |
$395.60
|
| Rate for Payer: Cigna Commercial |
$656.70
|
| Rate for Payer: First Health Commercial |
$751.64
|
| Rate for Payer: Humana Commercial |
$672.52
|
| Rate for Payer: Humana KY Medicaid |
$272.09
|
| Rate for Payer: Kentucky WC Medicaid |
$274.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.26
|
| Rate for Payer: Ohio Health Group HMO |
$593.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.93
|
| Rate for Payer: PHCS Commercial |
$759.55
|
| Rate for Payer: United Healthcare All Payer |
$696.26
|
|
|
GUIDEWIRE 2.0*6 ST
|
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
|
|
