|
GUIDEWIRE 2.8MM*300MM THRD
|
Facility
|
OP
|
$1,107.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.13 |
| Max. Negotiated Rate |
$1,062.82 |
| Rate for Payer: Aetna Commercial |
$852.47
|
| Rate for Payer: Anthem Medicaid |
$380.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$863.54
|
| Rate for Payer: Cash Price |
$553.55
|
| Rate for Payer: Cigna Commercial |
$918.89
|
| Rate for Payer: First Health Commercial |
$1,051.74
|
| Rate for Payer: Humana Commercial |
$941.03
|
| Rate for Payer: Humana KY Medicaid |
$380.73
|
| Rate for Payer: Kentucky WC Medicaid |
$384.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$907.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$974.25
|
| Rate for Payer: Ohio Health Group HMO |
$830.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$885.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.90
|
| Rate for Payer: PHCS Commercial |
$1,062.82
|
| Rate for Payer: United Healthcare All Payer |
$974.25
|
|
|
GUIDEWIRE 2.8MM*300MM THRD
|
Facility
|
IP
|
$1,107.10
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.13 |
| Max. Negotiated Rate |
$1,062.82 |
| Rate for Payer: Aetna Commercial |
$852.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$863.54
|
| Rate for Payer: Cash Price |
$553.55
|
| Rate for Payer: Cigna Commercial |
$918.89
|
| Rate for Payer: First Health Commercial |
$1,051.74
|
| Rate for Payer: Humana Commercial |
$941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$907.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$974.25
|
| Rate for Payer: Ohio Health Group HMO |
$830.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$885.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$763.90
|
| Rate for Payer: PHCS Commercial |
$1,062.82
|
| Rate for Payer: United Healthcare All Payer |
$974.25
|
|
|
GUIDEWIRE 3.0*28 BALL NOSE
|
Facility
|
IP
|
$1,844.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$1,770.61 |
| Rate for Payer: Aetna Commercial |
$1,420.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.62
|
| Rate for Payer: Cash Price |
$922.19
|
| Rate for Payer: Cigna Commercial |
$1,530.84
|
| Rate for Payer: First Health Commercial |
$1,752.17
|
| Rate for Payer: Humana Commercial |
$1,567.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.63
|
| Rate for Payer: PHCS Commercial |
$1,770.61
|
| Rate for Payer: United Healthcare All Payer |
$1,623.06
|
|
|
GUIDEWIRE 3.0*28 BALL NOSE
|
Facility
|
OP
|
$1,844.39
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$1,770.61 |
| Rate for Payer: Aetna Commercial |
$1,420.18
|
| Rate for Payer: Anthem Medicaid |
$634.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.62
|
| Rate for Payer: Cash Price |
$922.19
|
| Rate for Payer: Cigna Commercial |
$1,530.84
|
| Rate for Payer: First Health Commercial |
$1,752.17
|
| Rate for Payer: Humana Commercial |
$1,567.73
|
| Rate for Payer: Humana KY Medicaid |
$634.29
|
| Rate for Payer: Kentucky WC Medicaid |
$640.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.63
|
| Rate for Payer: PHCS Commercial |
$1,770.61
|
| Rate for Payer: United Healthcare All Payer |
$1,623.06
|
|
|
GUIDEWIRE 3.2*230 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 3.2*230 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 3.2*28 DRIVING WIRE
|
Facility
|
IP
|
$1,940.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.13 |
| Max. Negotiated Rate |
$1,862.83 |
| Rate for Payer: Aetna Commercial |
$1,494.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.55
|
| Rate for Payer: Cash Price |
$970.23
|
| Rate for Payer: Cigna Commercial |
$1,610.57
|
| Rate for Payer: First Health Commercial |
$1,843.43
|
| Rate for Payer: Humana Commercial |
$1,649.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,707.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.91
|
| Rate for Payer: PHCS Commercial |
$1,862.83
|
| Rate for Payer: United Healthcare All Payer |
$1,707.60
|
|
|
GUIDEWIRE 3.2*28 DRIVING WIRE
|
Facility
|
OP
|
$1,940.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.13 |
| Max. Negotiated Rate |
$1,862.83 |
| Rate for Payer: Aetna Commercial |
$1,494.15
|
| Rate for Payer: Anthem Medicaid |
$667.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.55
|
| Rate for Payer: Cash Price |
$970.23
|
| Rate for Payer: Cigna Commercial |
$1,610.57
|
| Rate for Payer: First Health Commercial |
$1,843.43
|
| Rate for Payer: Humana Commercial |
$1,649.38
|
| Rate for Payer: Humana KY Medicaid |
$667.32
|
| Rate for Payer: Kentucky WC Medicaid |
$674.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,707.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.91
|
| Rate for Payer: PHCS Commercial |
$1,862.83
|
| Rate for Payer: United Healthcare All Payer |
$1,707.60
|
|
|
GUIDEWIRE 3.2* 320MM
|
Facility
|
OP
|
$1,873.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.14 |
| Max. Negotiated Rate |
$1,798.85 |
| Rate for Payer: Aetna Commercial |
$1,442.83
|
| Rate for Payer: Anthem Medicaid |
$644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.56
|
| Rate for Payer: Cash Price |
$936.90
|
| Rate for Payer: Cigna Commercial |
$1,555.25
|
| Rate for Payer: First Health Commercial |
$1,780.11
|
| Rate for Payer: Humana Commercial |
$1,592.73
|
| Rate for Payer: Humana KY Medicaid |
$644.40
|
| Rate for Payer: Kentucky WC Medicaid |
$650.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.92
|
| Rate for Payer: PHCS Commercial |
$1,798.85
|
| Rate for Payer: United Healthcare All Payer |
$1,648.94
|
|
|
GUIDEWIRE 3.2* 320MM
|
Facility
|
IP
|
$1,873.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.14 |
| Max. Negotiated Rate |
$1,798.85 |
| Rate for Payer: Aetna Commercial |
$1,442.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.56
|
| Rate for Payer: Cash Price |
$936.90
|
| Rate for Payer: Cigna Commercial |
$1,555.25
|
| Rate for Payer: First Health Commercial |
$1,780.11
|
| Rate for Payer: Humana Commercial |
$1,592.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.92
|
| Rate for Payer: PHCS Commercial |
$1,798.85
|
| Rate for Payer: United Healthcare All Payer |
$1,648.94
|
|
|
GUIDE WIRE 3.2*400MM
|
Facility
|
OP
|
$1,704.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.45 |
| Max. Negotiated Rate |
$1,636.66 |
| Rate for Payer: Aetna Commercial |
$1,312.73
|
| Rate for Payer: Anthem Medicaid |
$586.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.78
|
| Rate for Payer: Cash Price |
$852.43
|
| Rate for Payer: Cigna Commercial |
$1,415.03
|
| Rate for Payer: First Health Commercial |
$1,619.61
|
| Rate for Payer: Humana Commercial |
$1,449.12
|
| Rate for Payer: Humana KY Medicaid |
$586.30
|
| Rate for Payer: Kentucky WC Medicaid |
$592.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,397.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.35
|
| Rate for Payer: PHCS Commercial |
$1,636.66
|
| Rate for Payer: United Healthcare All Payer |
$1,500.27
|
|
|
GUIDE WIRE 3.2*400MM
|
Facility
|
IP
|
$1,704.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.45 |
| Max. Negotiated Rate |
$1,636.66 |
| Rate for Payer: Aetna Commercial |
$1,312.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.78
|
| Rate for Payer: Cash Price |
$852.43
|
| Rate for Payer: Cigna Commercial |
$1,415.03
|
| Rate for Payer: First Health Commercial |
$1,619.61
|
| Rate for Payer: Humana Commercial |
$1,449.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,397.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.35
|
| Rate for Payer: PHCS Commercial |
$1,636.66
|
| Rate for Payer: United Healthcare All Payer |
$1,500.27
|
|
|
GUIDEWIRE .86 DOUBLE TIPPED
|
Facility
|
OP
|
$757.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.25 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna Commercial |
$583.27
|
| Rate for Payer: Anthem Medicaid |
$260.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.85
|
| Rate for Payer: Cash Price |
$378.75
|
| Rate for Payer: Cigna Commercial |
$628.73
|
| Rate for Payer: First Health Commercial |
$719.62
|
| Rate for Payer: Humana Commercial |
$643.88
|
| Rate for Payer: Humana KY Medicaid |
$260.50
|
| Rate for Payer: Kentucky WC Medicaid |
$263.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.60
|
| Rate for Payer: Ohio Health Group HMO |
$568.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$522.67
|
| Rate for Payer: PHCS Commercial |
$727.20
|
| Rate for Payer: United Healthcare All Payer |
$666.60
|
|
|
GUIDEWIRE .86 DOUBLE TIPPED
|
Facility
|
IP
|
$757.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.25 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna Commercial |
$583.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.85
|
| Rate for Payer: Cash Price |
$378.75
|
| Rate for Payer: Cigna Commercial |
$628.73
|
| Rate for Payer: First Health Commercial |
$719.62
|
| Rate for Payer: Humana Commercial |
$643.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.60
|
| Rate for Payer: Ohio Health Group HMO |
$568.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$522.67
|
| Rate for Payer: PHCS Commercial |
$727.20
|
| Rate for Payer: United Healthcare All Payer |
$666.60
|
|
|
GUIDEWIRE .86MM AR-8737-39
|
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 .86MM AR-8737-39
|
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 ACUTRAK2 PROBE 1.6MM
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK2 PROBE 1.6MM
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK2 PROBE 2.4MM
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK2 PROBE 2.4MM
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| 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 ACUTRAK PARLLEL .035
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
GUIDEWIRE ACUTRAK PARLLEL .035
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
GUIDEWIRE ACUTRK2 9.25*.094 TH
|
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 ACUTRK2 9.25*.094 TH
|
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 AMPLATZ PTFE CTD .03
|
Facility
|
OP
|
$750.79
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$720.76 |
| Rate for Payer: Aetna Commercial |
$578.11
|
| Rate for Payer: Anthem Medicaid |
$258.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.62
|
| Rate for Payer: Cash Price |
$375.40
|
| Rate for Payer: Cigna Commercial |
$623.16
|
| Rate for Payer: First Health Commercial |
$713.25
|
| Rate for Payer: Humana Commercial |
$638.17
|
| Rate for Payer: Humana KY Medicaid |
$258.20
|
| Rate for Payer: Kentucky WC Medicaid |
$260.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.70
|
| Rate for Payer: Ohio Health Group HMO |
$563.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.05
|
| Rate for Payer: PHCS Commercial |
$720.76
|
| Rate for Payer: United Healthcare All Payer |
$660.70
|
|
