|
GUIDEWIRE 2.0*6 ST
|
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 2.0MM 292.652
|
Facility
|
IP
|
$759.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.78 |
| Max. Negotiated Rate |
$728.88 |
| Rate for Payer: Aetna Commercial |
$584.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.22
|
| Rate for Payer: Cash Price |
$379.62
|
| Rate for Payer: Cigna Commercial |
$630.18
|
| Rate for Payer: First Health Commercial |
$721.29
|
| Rate for Payer: Humana Commercial |
$645.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$622.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.14
|
| Rate for Payer: Ohio Health Group HMO |
$569.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$607.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.88
|
| Rate for Payer: PHCS Commercial |
$728.88
|
| Rate for Payer: United Healthcare All Payer |
$668.14
|
|
|
GUIDEWIRE 2.0MM 292.652
|
Facility
|
OP
|
$759.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.78 |
| Max. Negotiated Rate |
$728.88 |
| Rate for Payer: Aetna Commercial |
$584.62
|
| Rate for Payer: Anthem Medicaid |
$261.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.22
|
| Rate for Payer: Cash Price |
$379.62
|
| Rate for Payer: Cigna Commercial |
$630.18
|
| Rate for Payer: First Health Commercial |
$721.29
|
| Rate for Payer: Humana Commercial |
$645.36
|
| Rate for Payer: Humana KY Medicaid |
$261.11
|
| Rate for Payer: Kentucky WC Medicaid |
$263.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$622.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.14
|
| Rate for Payer: Ohio Health Group HMO |
$569.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$607.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.88
|
| Rate for Payer: PHCS Commercial |
$728.88
|
| Rate for Payer: United Healthcare All Payer |
$668.14
|
|
|
GUIDE WIRE 2.0MMX9
|
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
|
|
|
GUIDE WIRE 2.0MMX9
|
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 2.2*800MM
|
Facility
|
OP
|
$1,824.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.32 |
| Max. Negotiated Rate |
$1,751.42 |
| Rate for Payer: Aetna Commercial |
$1,404.79
|
| Rate for Payer: Anthem Medicaid |
$627.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.03
|
| Rate for Payer: Cash Price |
$912.20
|
| Rate for Payer: Cigna Commercial |
$1,514.25
|
| Rate for Payer: First Health Commercial |
$1,733.18
|
| Rate for Payer: Humana Commercial |
$1,550.74
|
| Rate for Payer: Humana KY Medicaid |
$627.41
|
| Rate for Payer: Kentucky WC Medicaid |
$633.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,605.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,459.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.84
|
| Rate for Payer: PHCS Commercial |
$1,751.42
|
| Rate for Payer: United Healthcare All Payer |
$1,605.47
|
|
|
GUIDEWIRE 2.2*800MM
|
Facility
|
IP
|
$1,824.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.32 |
| Max. Negotiated Rate |
$1,751.42 |
| Rate for Payer: Aetna Commercial |
$1,404.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.03
|
| Rate for Payer: Cash Price |
$912.20
|
| Rate for Payer: Cigna Commercial |
$1,514.25
|
| Rate for Payer: First Health Commercial |
$1,733.18
|
| Rate for Payer: Humana Commercial |
$1,550.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,605.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,459.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.84
|
| Rate for Payer: PHCS Commercial |
$1,751.42
|
| Rate for Payer: United Healthcare All Payer |
$1,605.47
|
|
|
GUIDEWIRE 2.2MM*28 IN
|
Facility
|
IP
|
$1,808.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.48 |
| Max. Negotiated Rate |
$1,735.92 |
| Rate for Payer: Aetna Commercial |
$1,392.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.43
|
| Rate for Payer: Cash Price |
$904.12
|
| Rate for Payer: Cigna Commercial |
$1,500.85
|
| Rate for Payer: First Health Commercial |
$1,717.84
|
| Rate for Payer: Humana Commercial |
$1,537.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,446.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,573.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,247.69
|
| Rate for Payer: PHCS Commercial |
$1,735.92
|
| Rate for Payer: United Healthcare All Payer |
$1,591.26
|
|
|
GUIDEWIRE 2.2MM*28 IN
|
Facility
|
OP
|
$1,808.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.48 |
| Max. Negotiated Rate |
$1,735.92 |
| Rate for Payer: Aetna Commercial |
$1,392.35
|
| Rate for Payer: Anthem Medicaid |
$621.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.43
|
| Rate for Payer: Cash Price |
$904.12
|
| Rate for Payer: Cigna Commercial |
$1,500.85
|
| Rate for Payer: First Health Commercial |
$1,717.84
|
| Rate for Payer: Humana Commercial |
$1,537.01
|
| Rate for Payer: Humana KY Medicaid |
$621.86
|
| Rate for Payer: Kentucky WC Medicaid |
$628.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,446.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,573.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,247.69
|
| Rate for Payer: PHCS Commercial |
$1,735.92
|
| Rate for Payer: United Healthcare All Payer |
$1,591.26
|
|
|
GUIDEWIRE 2.4MM
|
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 2.4MM
|
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 2.4MM*12 AR-8967K-12
|
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 2.4MM*12 AR-8967K-12
|
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
|
|
|
GUIDEWIRE 2.4MM 8 AR-8967K
|
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 2.4MM 8 AR-8967K
|
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 2.4MM 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 2.4MM 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 2.5*800MM
|
Facility
|
OP
|
$1,816.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.04 |
| Max. Negotiated Rate |
$1,744.13 |
| Rate for Payer: Aetna Commercial |
$1,398.94
|
| Rate for Payer: Anthem Medicaid |
$624.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.10
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$1,507.94
|
| Rate for Payer: First Health Commercial |
$1,725.96
|
| Rate for Payer: Humana Commercial |
$1,544.28
|
| Rate for Payer: Humana KY Medicaid |
$624.80
|
| Rate for Payer: Kentucky WC Medicaid |
$631.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.59
|
| Rate for Payer: PHCS Commercial |
$1,744.13
|
| Rate for Payer: United Healthcare All Payer |
$1,598.78
|
|
|
GUIDEWIRE 2.5*800MM
|
Facility
|
IP
|
$1,816.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.04 |
| Max. Negotiated Rate |
$1,744.13 |
| Rate for Payer: Aetna Commercial |
$1,398.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.10
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$1,507.94
|
| Rate for Payer: First Health Commercial |
$1,725.96
|
| Rate for Payer: Humana Commercial |
$1,544.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.59
|
| Rate for Payer: PHCS Commercial |
$1,744.13
|
| Rate for Payer: United Healthcare All Payer |
$1,598.78
|
|
|
GUIDE WIRE 2.5MM THRD 230MM
|
Facility
|
IP
|
$1,109.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.97 |
| Max. Negotiated Rate |
$1,065.50 |
| Rate for Payer: Aetna Commercial |
$854.62
|
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$554.95
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$921.22
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: First Health Commercial |
$1,054.40
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana Commercial |
$943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.11
|
| 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 Benefit Exchange |
$332.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$832.42
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.61
|
| 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: Ohio Health Group PPO SOMC Employees |
$765.83
|
| Rate for Payer: PHCS Commercial |
$1,065.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$976.71
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
GUIDE WIRE 2.5MM THRD 230MM
|
Facility
|
OP
|
$1,109.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.97 |
| Max. Negotiated Rate |
$1,065.50 |
| Rate for Payer: Aetna Commercial |
$854.62
|
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$381.69
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$554.95
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: Cigna Commercial |
$921.22
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: First Health Commercial |
$1,054.40
|
| Rate for Payer: Humana Commercial |
$943.41
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$381.69
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Kentucky WC Medicaid |
$385.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$910.12
|
| 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: Medical Mutual Of Ohio POS/PPO/Traditional |
$819.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$976.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$832.42
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$765.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: PHCS Commercial |
$1,065.50
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
| Rate for Payer: United Healthcare All Payer |
$976.71
|
|
|
GUIDEWIRE 2.6MM
|
Facility
|
OP
|
$1,729.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$518.84 |
| Max. Negotiated Rate |
$1,660.30 |
| Rate for Payer: Aetna Commercial |
$1,331.70
|
| Rate for Payer: Anthem Medicaid |
$594.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.99
|
| Rate for Payer: Cash Price |
$864.74
|
| Rate for Payer: Cigna Commercial |
$1,435.47
|
| Rate for Payer: First Health Commercial |
$1,643.01
|
| Rate for Payer: Humana Commercial |
$1,470.06
|
| Rate for Payer: Humana KY Medicaid |
$594.77
|
| Rate for Payer: Kentucky WC Medicaid |
$600.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.34
|
| Rate for Payer: PHCS Commercial |
$1,660.30
|
| Rate for Payer: United Healthcare All Payer |
$1,521.94
|
|
|
GUIDEWIRE 2.6MM
|
Facility
|
IP
|
$1,729.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$518.84 |
| Max. Negotiated Rate |
$1,660.30 |
| Rate for Payer: Aetna Commercial |
$1,331.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.99
|
| Rate for Payer: Cash Price |
$864.74
|
| Rate for Payer: Cigna Commercial |
$1,435.47
|
| Rate for Payer: First Health Commercial |
$1,643.01
|
| Rate for Payer: Humana Commercial |
$1,470.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.34
|
| Rate for Payer: PHCS Commercial |
$1,660.30
|
| Rate for Payer: United Healthcare All Payer |
$1,521.94
|
|
|
GUIDEWIRE 2.8*450MM THREADED
|
Facility
|
OP
|
$1,510.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.04 |
| Max. Negotiated Rate |
$1,449.72 |
| Rate for Payer: Aetna Commercial |
$1,162.79
|
| Rate for Payer: Anthem Medicaid |
$519.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,177.89
|
| Rate for Payer: Cash Price |
$755.06
|
| Rate for Payer: Cigna Commercial |
$1,253.40
|
| Rate for Payer: First Health Commercial |
$1,434.61
|
| Rate for Payer: Humana Commercial |
$1,283.60
|
| Rate for Payer: Humana KY Medicaid |
$519.33
|
| Rate for Payer: Kentucky WC Medicaid |
$524.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,238.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,114.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$529.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,328.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,132.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,208.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,313.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.98
|
| Rate for Payer: PHCS Commercial |
$1,449.72
|
| Rate for Payer: United Healthcare All Payer |
$1,328.91
|
|
|
GUIDEWIRE 2.8*450MM THREADED
|
Facility
|
IP
|
$1,510.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.04 |
| Max. Negotiated Rate |
$1,449.72 |
| Rate for Payer: Aetna Commercial |
$1,162.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,177.89
|
| Rate for Payer: Cash Price |
$755.06
|
| Rate for Payer: Cigna Commercial |
$1,253.40
|
| Rate for Payer: First Health Commercial |
$1,434.61
|
| Rate for Payer: Humana Commercial |
$1,283.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,238.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,114.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,328.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,132.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,208.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,313.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.98
|
| Rate for Payer: PHCS Commercial |
$1,449.72
|
| Rate for Payer: United Healthcare All Payer |
$1,328.91
|
|
