|
GUIDEWIRE MEIER .035*185CM
|
Facility
|
OP
|
$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 Medicaid |
$402.36
|
| 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: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| 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: Molina Healthcare Medicaid |
$410.44
|
| 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
|
|
|
GUIDEWIRE MEIER .035*260CM
|
Facility
|
IP
|
$3,545.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,063.50 |
| Max. Negotiated Rate |
$3,403.20 |
| Rate for Payer: Aetna Commercial |
$2,729.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,765.10
|
| Rate for Payer: Cash Price |
$1,772.50
|
| Rate for Payer: Cigna Commercial |
$2,942.35
|
| Rate for Payer: First Health Commercial |
$3,367.75
|
| Rate for Payer: Humana Commercial |
$3,013.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,906.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,616.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,063.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,119.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,836.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,084.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.05
|
| Rate for Payer: PHCS Commercial |
$3,403.20
|
| Rate for Payer: United Healthcare All Payer |
$3,119.60
|
|
|
GUIDEWIRE MEIER .035*260CM
|
Facility
|
OP
|
$3,545.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,063.50 |
| Max. Negotiated Rate |
$3,403.20 |
| Rate for Payer: Aetna Commercial |
$2,729.65
|
| Rate for Payer: Anthem Medicaid |
$1,219.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,765.10
|
| Rate for Payer: Cash Price |
$1,772.50
|
| Rate for Payer: Cigna Commercial |
$2,942.35
|
| Rate for Payer: First Health Commercial |
$3,367.75
|
| Rate for Payer: Humana Commercial |
$3,013.25
|
| Rate for Payer: Humana KY Medicaid |
$1,219.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,231.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,906.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,616.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,063.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,243.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,119.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,836.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,084.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.05
|
| Rate for Payer: PHCS Commercial |
$3,403.20
|
| Rate for Payer: United Healthcare All Payer |
$3,119.60
|
|
|
GUIDEWIRE MICRO .018*130CM SS
|
Facility
|
OP
|
$1,132.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.60 |
| Max. Negotiated Rate |
$1,086.72 |
| Rate for Payer: Aetna Commercial |
$871.64
|
| Rate for Payer: Anthem Medicaid |
$389.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.96
|
| Rate for Payer: Cash Price |
$566.00
|
| Rate for Payer: Cigna Commercial |
$939.56
|
| Rate for Payer: First Health Commercial |
$1,075.40
|
| Rate for Payer: Humana Commercial |
$962.20
|
| Rate for Payer: Humana KY Medicaid |
$389.29
|
| Rate for Payer: Kentucky WC Medicaid |
$393.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.16
|
| Rate for Payer: Ohio Health Group HMO |
$849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$781.08
|
| Rate for Payer: PHCS Commercial |
$1,086.72
|
| Rate for Payer: United Healthcare All Payer |
$996.16
|
|
|
GUIDEWIRE MICRO .018*130CM SS
|
Facility
|
IP
|
$1,132.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.60 |
| Max. Negotiated Rate |
$1,086.72 |
| Rate for Payer: Aetna Commercial |
$871.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.96
|
| Rate for Payer: Cash Price |
$566.00
|
| Rate for Payer: Cigna Commercial |
$939.56
|
| Rate for Payer: First Health Commercial |
$1,075.40
|
| Rate for Payer: Humana Commercial |
$962.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.16
|
| Rate for Payer: Ohio Health Group HMO |
$849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$781.08
|
| Rate for Payer: PHCS Commercial |
$1,086.72
|
| Rate for Payer: United Healthcare All Payer |
$996.16
|
|
|
GUIDEWIRE MICRO .018*45CM SS
|
Facility
|
IP
|
$516.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.86 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Aetna Commercial |
$397.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.64
|
| Rate for Payer: Cash Price |
$258.10
|
| Rate for Payer: Cigna Commercial |
$428.45
|
| Rate for Payer: First Health Commercial |
$490.39
|
| Rate for Payer: Humana Commercial |
$438.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.26
|
| Rate for Payer: Ohio Health Group HMO |
$387.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.18
|
| Rate for Payer: PHCS Commercial |
$495.55
|
| Rate for Payer: United Healthcare All Payer |
$454.26
|
|
|
GUIDEWIRE MICRO .018*45CM SS
|
Facility
|
OP
|
$516.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.86 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Aetna Commercial |
$397.47
|
| Rate for Payer: Anthem Medicaid |
$177.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.64
|
| Rate for Payer: Cash Price |
$258.10
|
| Rate for Payer: Cigna Commercial |
$428.45
|
| Rate for Payer: First Health Commercial |
$490.39
|
| Rate for Payer: Humana Commercial |
$438.77
|
| Rate for Payer: Humana KY Medicaid |
$177.52
|
| Rate for Payer: Kentucky WC Medicaid |
$179.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.26
|
| Rate for Payer: Ohio Health Group HMO |
$387.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.18
|
| Rate for Payer: PHCS Commercial |
$495.55
|
| Rate for Payer: United Healthcare All Payer |
$454.26
|
|
|
GUIDEWIRE NAVIPRO .025*260 STR
|
Facility
|
IP
|
$1,740.04
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.01 |
| Max. Negotiated Rate |
$1,670.44 |
| Rate for Payer: Aetna Commercial |
$1,339.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.23
|
| Rate for Payer: Cash Price |
$870.02
|
| Rate for Payer: Cigna Commercial |
$1,444.23
|
| Rate for Payer: First Health Commercial |
$1,653.04
|
| Rate for Payer: Humana Commercial |
$1,479.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,513.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.63
|
| Rate for Payer: PHCS Commercial |
$1,670.44
|
| Rate for Payer: United Healthcare All Payer |
$1,531.24
|
|
|
GUIDEWIRE NAVIPRO .025*260 STR
|
Facility
|
OP
|
$1,740.04
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.01 |
| Max. Negotiated Rate |
$1,670.44 |
| Rate for Payer: Aetna Commercial |
$1,339.83
|
| Rate for Payer: Anthem Medicaid |
$598.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.23
|
| Rate for Payer: Cash Price |
$870.02
|
| Rate for Payer: Cigna Commercial |
$1,444.23
|
| Rate for Payer: First Health Commercial |
$1,653.04
|
| Rate for Payer: Humana Commercial |
$1,479.03
|
| Rate for Payer: Humana KY Medicaid |
$598.40
|
| Rate for Payer: Kentucky WC Medicaid |
$604.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,392.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,513.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.63
|
| Rate for Payer: PHCS Commercial |
$1,670.44
|
| Rate for Payer: United Healthcare All Payer |
$1,531.24
|
|
|
GUIDEWIRE NITINOL 2.0*20
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.50 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$920.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.10
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$991.85
|
| Rate for Payer: First Health Commercial |
$1,135.25
|
| Rate for Payer: Humana Commercial |
$1,015.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,051.60
|
| Rate for Payer: Ohio Health Group HMO |
$896.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,039.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$824.55
|
| Rate for Payer: PHCS Commercial |
$1,147.20
|
| Rate for Payer: United Healthcare All Payer |
$1,051.60
|
|
|
GUIDEWIRE NITINOL 2.0*20
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.50 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$920.15
|
| Rate for Payer: Anthem Medicaid |
$410.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.10
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$991.85
|
| Rate for Payer: First Health Commercial |
$1,135.25
|
| Rate for Payer: Humana Commercial |
$1,015.75
|
| Rate for Payer: Humana KY Medicaid |
$410.96
|
| Rate for Payer: Kentucky WC Medicaid |
$415.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,051.60
|
| Rate for Payer: Ohio Health Group HMO |
$896.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,039.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$824.55
|
| Rate for Payer: PHCS Commercial |
$1,147.20
|
| Rate for Payer: United Healthcare All Payer |
$1,051.60
|
|
|
GUIDEWIRE NON THRD 1.3*150
|
Facility
|
IP
|
$439.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
GUIDEWIRE NON THRD 1.3*150
|
Facility
|
OP
|
$439.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem Medicaid |
$151.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Humana KY Medicaid |
$151.06
|
| Rate for Payer: Kentucky WC Medicaid |
$152.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
GUIDEWIRE NON-THRDED 2.0M*250M
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
GUIDEWIRE NON-THRDED 2.0M*250M
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
GUIDE WIRE PCL 2.4MM*10
|
Facility
|
IP
|
$1,563.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.14 |
| Max. Negotiated Rate |
$1,501.26 |
| Rate for Payer: Aetna Commercial |
$1,204.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.77
|
| Rate for Payer: Cash Price |
$781.91
|
| Rate for Payer: Cigna Commercial |
$1,297.96
|
| Rate for Payer: First Health Commercial |
$1,485.62
|
| Rate for Payer: Humana Commercial |
$1,329.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,360.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.03
|
| Rate for Payer: PHCS Commercial |
$1,501.26
|
| Rate for Payer: United Healthcare All Payer |
$1,376.15
|
|
|
GUIDE WIRE PCL 2.4MM*10
|
Facility
|
OP
|
$1,563.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.14 |
| Max. Negotiated Rate |
$1,501.26 |
| Rate for Payer: Aetna Commercial |
$1,204.13
|
| Rate for Payer: Anthem Medicaid |
$537.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.77
|
| Rate for Payer: Cash Price |
$781.91
|
| Rate for Payer: Cigna Commercial |
$1,297.96
|
| Rate for Payer: First Health Commercial |
$1,485.62
|
| Rate for Payer: Humana Commercial |
$1,329.24
|
| Rate for Payer: Humana KY Medicaid |
$537.79
|
| Rate for Payer: Kentucky WC Medicaid |
$543.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,360.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.03
|
| Rate for Payer: PHCS Commercial |
$1,501.26
|
| Rate for Payer: United Healthcare All Payer |
$1,376.15
|
|
|
GUIDEWIRE PLATINUM .018 ST
|
Facility
|
IP
|
$1,495.11
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.53 |
| Max. Negotiated Rate |
$1,435.31 |
| Rate for Payer: Aetna Commercial |
$1,151.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.19
|
| Rate for Payer: Cash Price |
$747.55
|
| Rate for Payer: Cigna Commercial |
$1,240.94
|
| Rate for Payer: First Health Commercial |
$1,420.35
|
| Rate for Payer: Humana Commercial |
$1,270.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.63
|
| Rate for Payer: PHCS Commercial |
$1,435.31
|
| Rate for Payer: United Healthcare All Payer |
$1,315.70
|
|
|
GUIDEWIRE PLATINUM .018 ST
|
Facility
|
OP
|
$1,495.11
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.53 |
| Max. Negotiated Rate |
$1,435.31 |
| Rate for Payer: Aetna Commercial |
$1,151.23
|
| Rate for Payer: Anthem Medicaid |
$514.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.19
|
| Rate for Payer: Cash Price |
$747.55
|
| Rate for Payer: Cigna Commercial |
$1,240.94
|
| Rate for Payer: First Health Commercial |
$1,420.35
|
| Rate for Payer: Humana Commercial |
$1,270.84
|
| Rate for Payer: Humana KY Medicaid |
$514.17
|
| Rate for Payer: Kentucky WC Medicaid |
$519.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.63
|
| Rate for Payer: PHCS Commercial |
$1,435.31
|
| Rate for Payer: United Healthcare All Payer |
$1,315.70
|
|
|
GUIDEWIRE PLATINUM PLUS .025
|
Facility
|
OP
|
$1,548.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.44 |
| Max. Negotiated Rate |
$1,486.20 |
| Rate for Payer: Aetna Commercial |
$1,192.05
|
| Rate for Payer: Anthem Medicaid |
$532.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.53
|
| Rate for Payer: Cash Price |
$774.06
|
| Rate for Payer: Cigna Commercial |
$1,284.94
|
| Rate for Payer: First Health Commercial |
$1,470.71
|
| Rate for Payer: Humana Commercial |
$1,315.90
|
| Rate for Payer: Humana KY Medicaid |
$532.40
|
| Rate for Payer: Kentucky WC Medicaid |
$537.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,269.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,362.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,238.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,346.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.20
|
| Rate for Payer: PHCS Commercial |
$1,486.20
|
| Rate for Payer: United Healthcare All Payer |
$1,362.35
|
|
|
GUIDEWIRE PLATINUM PLUS .025
|
Facility
|
IP
|
$1,548.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.44 |
| Max. Negotiated Rate |
$1,486.20 |
| Rate for Payer: Aetna Commercial |
$1,192.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.53
|
| Rate for Payer: Cash Price |
$774.06
|
| Rate for Payer: Cigna Commercial |
$1,284.94
|
| Rate for Payer: First Health Commercial |
$1,470.71
|
| Rate for Payer: Humana Commercial |
$1,315.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,269.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,362.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,161.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,238.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,346.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.20
|
| Rate for Payer: PHCS Commercial |
$1,486.20
|
| Rate for Payer: United Healthcare All Payer |
$1,362.35
|
|
|
GUIDEWIRE POLARUS 3 20 TR TIP
|
Facility
|
OP
|
$1,519.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,458.43 |
| Rate for Payer: Aetna Commercial |
$1,169.78
|
| Rate for Payer: Anthem Medicaid |
$522.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.98
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,260.94
|
| Rate for Payer: First Health Commercial |
$1,443.24
|
| Rate for Payer: Humana Commercial |
$1,291.32
|
| Rate for Payer: Humana KY Medicaid |
$522.45
|
| Rate for Payer: Kentucky WC Medicaid |
$527.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.25
|
| Rate for Payer: PHCS Commercial |
$1,458.43
|
| Rate for Payer: United Healthcare All Payer |
$1,336.90
|
|
|
GUIDEWIRE POLARUS 3 20 TR TIP
|
Facility
|
IP
|
$1,519.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$1,458.43 |
| Rate for Payer: Aetna Commercial |
$1,169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.98
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,260.94
|
| Rate for Payer: First Health Commercial |
$1,443.24
|
| Rate for Payer: Humana Commercial |
$1,291.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.25
|
| Rate for Payer: PHCS Commercial |
$1,458.43
|
| Rate for Payer: United Healthcare All Payer |
$1,336.90
|
|
|
GUIDEWIRE PTFE FX CORE STR .02
|
Facility
|
OP
|
$439.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.74 |
| Max. Negotiated Rate |
$421.56 |
| Rate for Payer: Aetna Commercial |
$338.12
|
| Rate for Payer: Anthem Medicaid |
$151.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.51
|
| Rate for Payer: Cash Price |
$219.56
|
| Rate for Payer: Cigna Commercial |
$364.47
|
| Rate for Payer: First Health Commercial |
$417.16
|
| Rate for Payer: Humana Commercial |
$373.25
|
| Rate for Payer: Humana KY Medicaid |
$151.01
|
| Rate for Payer: Kentucky WC Medicaid |
$152.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.43
|
| Rate for Payer: Ohio Health Group HMO |
$329.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.99
|
| Rate for Payer: PHCS Commercial |
$421.56
|
| Rate for Payer: United Healthcare All Payer |
$386.43
|
|
|
GUIDEWIRE PTFE FX CORE STR .02
|
Facility
|
IP
|
$439.12
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.74 |
| Max. Negotiated Rate |
$421.56 |
| Rate for Payer: Aetna Commercial |
$338.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.51
|
| Rate for Payer: Cash Price |
$219.56
|
| Rate for Payer: Cigna Commercial |
$364.47
|
| Rate for Payer: First Health Commercial |
$417.16
|
| Rate for Payer: Humana Commercial |
$373.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.43
|
| Rate for Payer: Ohio Health Group HMO |
$329.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.99
|
| Rate for Payer: PHCS Commercial |
$421.56
|
| Rate for Payer: United Healthcare All Payer |
$386.43
|
|
