|
GUIDEWIRE FIXED CORE 260CM
|
Facility
|
IP
|
$464.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.47 |
| Max. Negotiated Rate |
$446.30 |
| Rate for Payer: Aetna Commercial |
$357.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.62
|
| Rate for Payer: Cash Price |
$232.45
|
| Rate for Payer: Cigna Commercial |
$385.87
|
| Rate for Payer: First Health Commercial |
$441.65
|
| Rate for Payer: Humana Commercial |
$395.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.11
|
| Rate for Payer: Ohio Health Group HMO |
$348.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.78
|
| Rate for Payer: PHCS Commercial |
$446.30
|
| Rate for Payer: United Healthcare All Payer |
$409.11
|
|
|
GUIDEWIRE FIXED CORE 260CM
|
Facility
|
OP
|
$464.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.47 |
| Max. Negotiated Rate |
$446.30 |
| Rate for Payer: Aetna Commercial |
$357.97
|
| Rate for Payer: Anthem Medicaid |
$159.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.62
|
| Rate for Payer: Cash Price |
$232.45
|
| Rate for Payer: Cigna Commercial |
$385.87
|
| Rate for Payer: First Health Commercial |
$441.65
|
| Rate for Payer: Humana Commercial |
$395.17
|
| Rate for Payer: Humana KY Medicaid |
$159.88
|
| Rate for Payer: Kentucky WC Medicaid |
$161.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.11
|
| Rate for Payer: Ohio Health Group HMO |
$348.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.78
|
| Rate for Payer: PHCS Commercial |
$446.30
|
| Rate for Payer: United Healthcare All Payer |
$409.11
|
|
|
GUIDEWIRE FLOPPY TIP NITINOL
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,161.60 |
| Rate for Payer: Aetna Commercial |
$931.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$943.80
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$1,004.30
|
| Rate for Payer: First Health Commercial |
$1,149.50
|
| Rate for Payer: Humana Commercial |
$1,028.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$992.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,064.80
|
| Rate for Payer: Ohio Health Group HMO |
$907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.90
|
| Rate for Payer: PHCS Commercial |
$1,161.60
|
| Rate for Payer: United Healthcare All Payer |
$1,064.80
|
|
|
GUIDEWIRE FLOPPY TIP NITINOL
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,161.60 |
| Rate for Payer: Aetna Commercial |
$931.70
|
| Rate for Payer: Anthem Medicaid |
$416.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$943.80
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$1,004.30
|
| Rate for Payer: First Health Commercial |
$1,149.50
|
| Rate for Payer: Humana Commercial |
$1,028.50
|
| Rate for Payer: Humana KY Medicaid |
$416.12
|
| Rate for Payer: Kentucky WC Medicaid |
$420.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$992.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$424.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,064.80
|
| Rate for Payer: Ohio Health Group HMO |
$907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.90
|
| Rate for Payer: PHCS Commercial |
$1,161.60
|
| Rate for Payer: United Healthcare All Payer |
$1,064.80
|
|
|
GUIDE WIRE F/POLARUS 2MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem Medicaid |
$385.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Humana KY Medicaid |
$385.17
|
| Rate for Payer: Kentucky WC Medicaid |
$389.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
GUIDE WIRE F/POLARUS 2MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
GUIDEWIRE HALO
|
Facility
|
IP
|
$1,843.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.02 |
| Max. Negotiated Rate |
$1,769.66 |
| Rate for Payer: Aetna Commercial |
$1,419.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,437.85
|
| Rate for Payer: Cash Price |
$921.70
|
| Rate for Payer: Cigna Commercial |
$1,530.02
|
| Rate for Payer: First Health Commercial |
$1,751.23
|
| Rate for Payer: Humana Commercial |
$1,566.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,511.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,382.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,603.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.95
|
| Rate for Payer: PHCS Commercial |
$1,769.66
|
| Rate for Payer: United Healthcare All Payer |
$1,622.19
|
|
|
GUIDEWIRE HALO
|
Facility
|
OP
|
$1,843.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.02 |
| Max. Negotiated Rate |
$1,769.66 |
| Rate for Payer: Aetna Commercial |
$1,419.42
|
| Rate for Payer: Anthem Medicaid |
$633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,437.85
|
| Rate for Payer: Cash Price |
$921.70
|
| Rate for Payer: Cigna Commercial |
$1,530.02
|
| Rate for Payer: First Health Commercial |
$1,751.23
|
| Rate for Payer: Humana Commercial |
$1,566.89
|
| Rate for Payer: Humana KY Medicaid |
$633.95
|
| Rate for Payer: Kentucky WC Medicaid |
$640.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,511.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,382.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,603.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.95
|
| Rate for Payer: PHCS Commercial |
$1,769.66
|
| Rate for Payer: United Healthcare All Payer |
$1,622.19
|
|
|
GUIDEWIRE HYDRA JAGWIRE ST 260
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
GUIDEWIRE HYDRA JAGWIRE ST 260
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
GUIDEWIRE J CVD .035*180CM
|
Facility
|
OP
|
$837.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.21 |
| Max. Negotiated Rate |
$803.86 |
| Rate for Payer: Aetna Commercial |
$644.76
|
| Rate for Payer: Anthem Medicaid |
$287.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.13
|
| Rate for Payer: Cash Price |
$418.68
|
| Rate for Payer: Cigna Commercial |
$695.00
|
| Rate for Payer: First Health Commercial |
$795.48
|
| Rate for Payer: Humana Commercial |
$711.75
|
| Rate for Payer: Humana KY Medicaid |
$287.96
|
| Rate for Payer: Kentucky WC Medicaid |
$290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.87
|
| Rate for Payer: Ohio Health Group HMO |
$628.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.77
|
| Rate for Payer: PHCS Commercial |
$803.86
|
| Rate for Payer: United Healthcare All Payer |
$736.87
|
|
|
GUIDEWIRE J CVD .035*180CM
|
Facility
|
IP
|
$837.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.21 |
| Max. Negotiated Rate |
$803.86 |
| Rate for Payer: Aetna Commercial |
$644.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.13
|
| Rate for Payer: Cash Price |
$418.68
|
| Rate for Payer: Cigna Commercial |
$695.00
|
| Rate for Payer: First Health Commercial |
$795.48
|
| Rate for Payer: Humana Commercial |
$711.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.87
|
| Rate for Payer: Ohio Health Group HMO |
$628.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.77
|
| Rate for Payer: PHCS Commercial |
$803.86
|
| Rate for Payer: United Healthcare All Payer |
$736.87
|
|
|
GUIDEWIRE J CVD .035*260CM
|
Facility
|
IP
|
$454.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.25 |
| Max. Negotiated Rate |
$436.01 |
| Rate for Payer: Aetna Commercial |
$349.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.26
|
| Rate for Payer: Cash Price |
$227.09
|
| Rate for Payer: Cigna Commercial |
$376.97
|
| Rate for Payer: First Health Commercial |
$431.47
|
| Rate for Payer: Humana Commercial |
$386.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.68
|
| Rate for Payer: Ohio Health Group HMO |
$340.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.38
|
| Rate for Payer: PHCS Commercial |
$436.01
|
| Rate for Payer: United Healthcare All Payer |
$399.68
|
|
|
GUIDEWIRE J CVD .035*260CM
|
Facility
|
OP
|
$454.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.25 |
| Max. Negotiated Rate |
$436.01 |
| Rate for Payer: Aetna Commercial |
$349.72
|
| Rate for Payer: Anthem Medicaid |
$156.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.26
|
| Rate for Payer: Cash Price |
$227.09
|
| Rate for Payer: Cigna Commercial |
$376.97
|
| Rate for Payer: First Health Commercial |
$431.47
|
| Rate for Payer: Humana Commercial |
$386.05
|
| Rate for Payer: Humana KY Medicaid |
$156.19
|
| Rate for Payer: Kentucky WC Medicaid |
$157.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.68
|
| Rate for Payer: Ohio Health Group HMO |
$340.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.38
|
| Rate for Payer: PHCS Commercial |
$436.01
|
| Rate for Payer: United Healthcare All Payer |
$399.68
|
|
|
GUIDEWIRE JINDO .022-.035 180C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GUIDEWIRE JINDO .022-.035 180C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GUIDEWIRE 'J' TIP 0.14
|
Facility
|
OP
|
$1,732.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.67 |
| Max. Negotiated Rate |
$1,662.96 |
| Rate for Payer: Aetna Commercial |
$1,333.83
|
| Rate for Payer: Anthem Medicaid |
$595.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.15
|
| Rate for Payer: Cash Price |
$866.12
|
| Rate for Payer: Cigna Commercial |
$1,437.77
|
| Rate for Payer: First Health Commercial |
$1,645.64
|
| Rate for Payer: Humana Commercial |
$1,472.41
|
| Rate for Payer: Humana KY Medicaid |
$595.72
|
| Rate for Payer: Kentucky WC Medicaid |
$601.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,420.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,278.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,385.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.25
|
| Rate for Payer: PHCS Commercial |
$1,662.96
|
| Rate for Payer: United Healthcare All Payer |
$1,524.38
|
|
|
GUIDEWIRE 'J' TIP 0.14
|
Facility
|
IP
|
$1,732.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.67 |
| Max. Negotiated Rate |
$1,662.96 |
| Rate for Payer: Aetna Commercial |
$1,333.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.15
|
| Rate for Payer: Cash Price |
$866.12
|
| Rate for Payer: Cigna Commercial |
$1,437.77
|
| Rate for Payer: First Health Commercial |
$1,645.64
|
| Rate for Payer: Humana Commercial |
$1,472.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,420.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,278.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,385.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,507.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.25
|
| Rate for Payer: PHCS Commercial |
$1,662.96
|
| Rate for Payer: United Healthcare All Payer |
$1,524.38
|
|
|
GUIDEWIRE MAGIC TORQUE .035*26
|
Facility
|
OP
|
$1,103.17
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.95 |
| Max. Negotiated Rate |
$1,059.04 |
| Rate for Payer: Aetna Commercial |
$849.44
|
| Rate for Payer: Anthem Medicaid |
$379.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$860.47
|
| Rate for Payer: Cash Price |
$551.58
|
| Rate for Payer: Cigna Commercial |
$915.63
|
| Rate for Payer: First Health Commercial |
$1,048.01
|
| Rate for Payer: Humana Commercial |
$937.69
|
| Rate for Payer: Humana KY Medicaid |
$379.38
|
| Rate for Payer: Kentucky WC Medicaid |
$383.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$386.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$970.79
|
| Rate for Payer: Ohio Health Group HMO |
$827.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$761.19
|
| Rate for Payer: PHCS Commercial |
$1,059.04
|
| Rate for Payer: United Healthcare All Payer |
$970.79
|
|
|
GUIDEWIRE MAGIC TORQUE .035*26
|
Facility
|
IP
|
$1,103.17
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.95 |
| Max. Negotiated Rate |
$1,059.04 |
| Rate for Payer: Aetna Commercial |
$849.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$860.47
|
| Rate for Payer: Cash Price |
$551.58
|
| Rate for Payer: Cigna Commercial |
$915.63
|
| Rate for Payer: First Health Commercial |
$1,048.01
|
| Rate for Payer: Humana Commercial |
$937.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$970.79
|
| Rate for Payer: Ohio Health Group HMO |
$827.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$761.19
|
| Rate for Payer: PHCS Commercial |
$1,059.04
|
| Rate for Payer: United Healthcare All Payer |
$970.79
|
|
|
GUIDEWIRE MAXXWIRE .035*180 S
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
GUIDEWIRE MAXXWIRE .035*180 S
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem Medicaid |
$517.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Humana KY Medicaid |
$517.23
|
| Rate for Payer: Kentucky WC Medicaid |
$522.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
GUIDEWIRE MAXXWIRE .035*180 SS
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
GUIDEWIRE MAXXWIRE .035*180 SS
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem Medicaid |
$517.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Humana KY Medicaid |
$517.23
|
| Rate for Payer: Kentucky WC Medicaid |
$522.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
GUIDEWIRE MEIER .035*185CM
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
