|
GUIDEWIRE AMPLATZ PTFE CTD .03
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
GUIDEWIRE AMPLATZ STR 0.35*72C
|
Facility
|
OP
|
$547.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.18 |
| Max. Negotiated Rate |
$525.36 |
| Rate for Payer: Aetna Commercial |
$421.38
|
| Rate for Payer: Anthem Medicaid |
$188.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.86
|
| Rate for Payer: Cash Price |
$273.62
|
| Rate for Payer: Cigna Commercial |
$454.22
|
| Rate for Payer: First Health Commercial |
$519.89
|
| Rate for Payer: Humana Commercial |
$465.16
|
| Rate for Payer: Humana KY Medicaid |
$188.20
|
| Rate for Payer: Kentucky WC Medicaid |
$190.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.58
|
| Rate for Payer: Ohio Health Group HMO |
$410.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.60
|
| Rate for Payer: PHCS Commercial |
$525.36
|
| Rate for Payer: United Healthcare All Payer |
$481.58
|
|
|
GUIDEWIRE AMPLATZ STR 0.35*72C
|
Facility
|
IP
|
$547.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.18 |
| Max. Negotiated Rate |
$525.36 |
| Rate for Payer: Aetna Commercial |
$421.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.86
|
| Rate for Payer: Cash Price |
$273.62
|
| Rate for Payer: Cigna Commercial |
$454.22
|
| Rate for Payer: First Health Commercial |
$519.89
|
| Rate for Payer: Humana Commercial |
$465.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.58
|
| Rate for Payer: Ohio Health Group HMO |
$410.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.60
|
| Rate for Payer: PHCS Commercial |
$525.36
|
| Rate for Payer: United Healthcare All Payer |
$481.58
|
|
|
GUIDEWIRE ANIS III 2.0*150MM
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,013.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$803.85
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
GUIDEWIRE ANIS III 2.0*150MM
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem Medicaid |
$400.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Humana KY Medicaid |
$400.64
|
| Rate for Payer: Kentucky WC Medicaid |
$404.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$408.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,013.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$803.85
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
GUIDEWIRE BENTSON PTFE CTD .03
|
Facility
|
OP
|
$1,169.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.85 |
| Max. Negotiated Rate |
$1,122.72 |
| Rate for Payer: Aetna Commercial |
$900.51
|
| Rate for Payer: Anthem Medicaid |
$402.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.21
|
| Rate for Payer: Cash Price |
$584.75
|
| Rate for Payer: Cigna Commercial |
$970.68
|
| Rate for Payer: First Health Commercial |
$1,111.03
|
| Rate for Payer: Humana Commercial |
$994.08
|
| Rate for Payer: Humana KY Medicaid |
$402.19
|
| Rate for Payer: Kentucky WC Medicaid |
$406.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$958.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.16
|
| Rate for Payer: Ohio Health Group HMO |
$877.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.96
|
| Rate for Payer: PHCS Commercial |
$1,122.72
|
| Rate for Payer: United Healthcare All Payer |
$1,029.16
|
|
|
GUIDEWIRE BENTSON PTFE CTD .03
|
Facility
|
IP
|
$1,169.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.85 |
| Max. Negotiated Rate |
$1,122.72 |
| Rate for Payer: Aetna Commercial |
$900.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.21
|
| Rate for Payer: Cash Price |
$584.75
|
| Rate for Payer: Cigna Commercial |
$970.68
|
| Rate for Payer: First Health Commercial |
$1,111.03
|
| Rate for Payer: Humana Commercial |
$994.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$958.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.16
|
| Rate for Payer: Ohio Health Group HMO |
$877.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.96
|
| Rate for Payer: PHCS Commercial |
$1,122.72
|
| Rate for Payer: United Healthcare All Payer |
$1,029.16
|
|
|
GUIDEWIRE CONTROL .018*8*200
|
Facility
|
OP
|
$1,549.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.96 |
| Max. Negotiated Rate |
$1,487.88 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Anthem Medicaid |
$533.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.90
|
| Rate for Payer: Cash Price |
$774.93
|
| Rate for Payer: Cigna Commercial |
$1,286.39
|
| Rate for Payer: First Health Commercial |
$1,472.38
|
| Rate for Payer: Humana Commercial |
$1,317.39
|
| Rate for Payer: Humana KY Medicaid |
$533.00
|
| Rate for Payer: Kentucky WC Medicaid |
$538.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,239.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.41
|
| Rate for Payer: PHCS Commercial |
$1,487.88
|
| Rate for Payer: United Healthcare All Payer |
$1,363.89
|
|
|
GUIDEWIRE CONTROL .018*8*200
|
Facility
|
IP
|
$1,549.87
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.96 |
| Max. Negotiated Rate |
$1,487.88 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,208.90
|
| Rate for Payer: Cash Price |
$774.93
|
| Rate for Payer: Cigna Commercial |
$1,286.39
|
| Rate for Payer: First Health Commercial |
$1,472.38
|
| Rate for Payer: Humana Commercial |
$1,317.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,270.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,363.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,239.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.41
|
| Rate for Payer: PHCS Commercial |
$1,487.88
|
| Rate for Payer: United Healthcare All Payer |
$1,363.89
|
|
|
GUIDEWIRE CONTROL .018*8*300
|
Facility
|
OP
|
$1,567.54
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.26 |
| Max. Negotiated Rate |
$1,504.84 |
| Rate for Payer: Aetna Commercial |
$1,207.01
|
| Rate for Payer: Anthem Medicaid |
$539.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,222.68
|
| Rate for Payer: Cash Price |
$783.77
|
| Rate for Payer: Cigna Commercial |
$1,301.06
|
| Rate for Payer: First Health Commercial |
$1,489.16
|
| Rate for Payer: Humana Commercial |
$1,332.41
|
| Rate for Payer: Humana KY Medicaid |
$539.08
|
| Rate for Payer: Kentucky WC Medicaid |
$544.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,285.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,156.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,379.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,175.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,254.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,363.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,081.60
|
| Rate for Payer: PHCS Commercial |
$1,504.84
|
| Rate for Payer: United Healthcare All Payer |
$1,379.44
|
|
|
GUIDEWIRE CONTROL .018*8*300
|
Facility
|
IP
|
$1,567.54
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.26 |
| Max. Negotiated Rate |
$1,504.84 |
| Rate for Payer: Aetna Commercial |
$1,207.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,222.68
|
| Rate for Payer: Cash Price |
$783.77
|
| Rate for Payer: Cigna Commercial |
$1,301.06
|
| Rate for Payer: First Health Commercial |
$1,489.16
|
| Rate for Payer: Humana Commercial |
$1,332.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,285.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,156.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,379.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,175.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,254.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,363.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,081.60
|
| Rate for Payer: PHCS Commercial |
$1,504.84
|
| Rate for Payer: United Healthcare All Payer |
$1,379.44
|
|
|
GUIDEWIRE COUGAR XT .014*190CM
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem Medicaid |
$636.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Humana KY Medicaid |
$636.56
|
| Rate for Payer: Kentucky WC Medicaid |
$643.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
GUIDEWIRE COUGAR XT .014*190CM
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
GUIDEWIRE COUGAR XT .014*300CM
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem Medicaid |
$407.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Humana KY Medicaid |
$407.52
|
| Rate for Payer: Kentucky WC Medicaid |
$411.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
GUIDEWIRE COUGAR XT .014*300CM
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
GUIDEWIRE C-TSCF-35-125-SPENCE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE C-TSCF-35-125-SPENCE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GUIDEWIRE DBL TIPPED 1.1MM
|
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 DBL TIPPED 1.1MM
|
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 E-Z GLIDER ANG .025
|
Facility
|
IP
|
$782.97
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.89 |
| Max. Negotiated Rate |
$751.65 |
| Rate for Payer: Aetna Commercial |
$602.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.72
|
| Rate for Payer: Cash Price |
$391.48
|
| Rate for Payer: Cigna Commercial |
$649.87
|
| Rate for Payer: First Health Commercial |
$743.82
|
| Rate for Payer: Humana Commercial |
$665.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.01
|
| Rate for Payer: Ohio Health Group HMO |
$587.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.25
|
| Rate for Payer: PHCS Commercial |
$751.65
|
| Rate for Payer: United Healthcare All Payer |
$689.01
|
|
|
GUIDEWIRE E-Z GLIDER ANG .025
|
Facility
|
OP
|
$782.97
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.89 |
| Max. Negotiated Rate |
$751.65 |
| Rate for Payer: Aetna Commercial |
$602.89
|
| Rate for Payer: Anthem Medicaid |
$269.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.72
|
| Rate for Payer: Cash Price |
$391.48
|
| Rate for Payer: Cigna Commercial |
$649.87
|
| Rate for Payer: First Health Commercial |
$743.82
|
| Rate for Payer: Humana Commercial |
$665.52
|
| Rate for Payer: Humana KY Medicaid |
$269.26
|
| Rate for Payer: Kentucky WC Medicaid |
$272.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$274.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.01
|
| Rate for Payer: Ohio Health Group HMO |
$587.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.25
|
| Rate for Payer: PHCS Commercial |
$751.65
|
| Rate for Payer: United Healthcare All Payer |
$689.01
|
|
|
GUIDEWIRE E-Z GLIDER STR .025
|
Facility
|
OP
|
$566.68
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$544.01 |
| Rate for Payer: Aetna Commercial |
$436.34
|
| Rate for Payer: Anthem Medicaid |
$194.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$442.01
|
| Rate for Payer: Cash Price |
$283.34
|
| Rate for Payer: Cigna Commercial |
$470.34
|
| Rate for Payer: First Health Commercial |
$538.35
|
| Rate for Payer: Humana Commercial |
$481.68
|
| Rate for Payer: Humana KY Medicaid |
$194.88
|
| Rate for Payer: Kentucky WC Medicaid |
$196.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.68
|
| Rate for Payer: Ohio Health Group HMO |
$425.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.01
|
| Rate for Payer: PHCS Commercial |
$544.01
|
| Rate for Payer: United Healthcare All Payer |
$498.68
|
|
|
GUIDEWIRE E-Z GLIDER STR .025
|
Facility
|
IP
|
$566.68
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$544.01 |
| Rate for Payer: Aetna Commercial |
$436.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$442.01
|
| Rate for Payer: Cash Price |
$283.34
|
| Rate for Payer: Cigna Commercial |
$470.34
|
| Rate for Payer: First Health Commercial |
$538.35
|
| Rate for Payer: Humana Commercial |
$481.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.68
|
| Rate for Payer: Ohio Health Group HMO |
$425.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.01
|
| Rate for Payer: PHCS Commercial |
$544.01
|
| Rate for Payer: United Healthcare All Payer |
$498.68
|
|
|
GUIDEWIRE FIXED CORE .015*15CM
|
Facility
|
IP
|
$473.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.02 |
| Max. Negotiated Rate |
$454.46 |
| Rate for Payer: Aetna Commercial |
$364.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.25
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: First Health Commercial |
$449.73
|
| Rate for Payer: Humana Commercial |
$402.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.59
|
| Rate for Payer: Ohio Health Group HMO |
$355.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.65
|
| Rate for Payer: PHCS Commercial |
$454.46
|
| Rate for Payer: United Healthcare All Payer |
$416.59
|
|
|
GUIDEWIRE FIXED CORE .015*15CM
|
Facility
|
OP
|
$473.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.02 |
| Max. Negotiated Rate |
$454.46 |
| Rate for Payer: Aetna Commercial |
$364.52
|
| Rate for Payer: Anthem Medicaid |
$162.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.25
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: First Health Commercial |
$449.73
|
| Rate for Payer: Humana Commercial |
$402.39
|
| Rate for Payer: Humana KY Medicaid |
$162.80
|
| Rate for Payer: Kentucky WC Medicaid |
$164.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.59
|
| Rate for Payer: Ohio Health Group HMO |
$355.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.65
|
| Rate for Payer: PHCS Commercial |
$454.46
|
| Rate for Payer: United Healthcare All Payer |
$416.59
|
|
