|
GUIDEWIRE ROSENN .035*180*3CM
|
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 ROSENN .035*180*3CM
|
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 SHT TAPER .018*190
|
Facility
|
OP
|
$1,711.05
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.32 |
| Max. Negotiated Rate |
$1,642.61 |
| Rate for Payer: Aetna Commercial |
$1,317.51
|
| Rate for Payer: Anthem Medicaid |
$588.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.62
|
| Rate for Payer: Cash Price |
$855.52
|
| Rate for Payer: Cigna Commercial |
$1,420.17
|
| Rate for Payer: First Health Commercial |
$1,625.50
|
| Rate for Payer: Humana Commercial |
$1,454.39
|
| Rate for Payer: Humana KY Medicaid |
$588.43
|
| Rate for Payer: Kentucky WC Medicaid |
$594.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,403.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,283.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.62
|
| Rate for Payer: PHCS Commercial |
$1,642.61
|
| Rate for Payer: United Healthcare All Payer |
$1,505.72
|
|
|
GUIDEWIRE SHT TAPER .018*190
|
Facility
|
IP
|
$1,711.05
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.32 |
| Max. Negotiated Rate |
$1,642.61 |
| Rate for Payer: Aetna Commercial |
$1,317.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.62
|
| Rate for Payer: Cash Price |
$855.52
|
| Rate for Payer: Cigna Commercial |
$1,420.17
|
| Rate for Payer: First Health Commercial |
$1,625.50
|
| Rate for Payer: Humana Commercial |
$1,454.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,403.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,283.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.62
|
| Rate for Payer: PHCS Commercial |
$1,642.61
|
| Rate for Payer: United Healthcare All Payer |
$1,505.72
|
|
|
GUIDEWIRE SMTH TIP/3.2M*98C
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
GUIDEWIRE SMTH TIP/3.2M*98C
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
GUIDE WIRE ST .059*5
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
GUIDE WIRE ST .059*5
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$153.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$153.38
|
| Rate for Payer: Kentucky WC Medicaid |
$154.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
GUIDE WIRE ST .062*9
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
GUIDE WIRE ST .062*9
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
GUIDEWIRE ST. 150CM
|
Facility
|
IP
|
$486.69
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.01 |
| Max. Negotiated Rate |
$467.22 |
| Rate for Payer: Aetna Commercial |
$374.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.62
|
| Rate for Payer: Cash Price |
$243.34
|
| Rate for Payer: Cigna Commercial |
$403.95
|
| Rate for Payer: First Health Commercial |
$462.36
|
| Rate for Payer: Humana Commercial |
$413.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.29
|
| Rate for Payer: Ohio Health Group HMO |
$365.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.82
|
| Rate for Payer: PHCS Commercial |
$467.22
|
| Rate for Payer: United Healthcare All Payer |
$428.29
|
|
|
GUIDEWIRE ST. 150CM
|
Facility
|
OP
|
$486.69
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.01 |
| Max. Negotiated Rate |
$467.22 |
| Rate for Payer: Aetna Commercial |
$374.75
|
| Rate for Payer: Anthem Medicaid |
$167.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.62
|
| Rate for Payer: Cash Price |
$243.34
|
| Rate for Payer: Cigna Commercial |
$403.95
|
| Rate for Payer: First Health Commercial |
$462.36
|
| Rate for Payer: Humana Commercial |
$413.69
|
| Rate for Payer: Humana KY Medicaid |
$167.37
|
| Rate for Payer: Kentucky WC Medicaid |
$169.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.29
|
| Rate for Payer: Ohio Health Group HMO |
$365.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.82
|
| Rate for Payer: PHCS Commercial |
$467.22
|
| Rate for Payer: United Healthcare All Payer |
$428.29
|
|
|
GUIDE WIRE ST 2.0*9
|
Facility
|
IP
|
$486.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.95 |
| Max. Negotiated Rate |
$467.04 |
| Rate for Payer: Aetna Commercial |
$374.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.47
|
| Rate for Payer: Cash Price |
$243.25
|
| Rate for Payer: Cigna Commercial |
$403.80
|
| Rate for Payer: First Health Commercial |
$462.18
|
| Rate for Payer: Humana Commercial |
$413.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.12
|
| Rate for Payer: Ohio Health Group HMO |
$364.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.69
|
| Rate for Payer: PHCS Commercial |
$467.04
|
| Rate for Payer: United Healthcare All Payer |
$428.12
|
|
|
GUIDE WIRE ST 2.0*9
|
Facility
|
OP
|
$486.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.95 |
| Max. Negotiated Rate |
$467.04 |
| Rate for Payer: Aetna Commercial |
$374.61
|
| Rate for Payer: Anthem Medicaid |
$167.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.47
|
| Rate for Payer: Cash Price |
$243.25
|
| Rate for Payer: Cigna Commercial |
$403.80
|
| Rate for Payer: First Health Commercial |
$462.18
|
| Rate for Payer: Humana Commercial |
$413.52
|
| Rate for Payer: Humana KY Medicaid |
$167.31
|
| Rate for Payer: Kentucky WC Medicaid |
$169.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.12
|
| Rate for Payer: Ohio Health Group HMO |
$364.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.69
|
| Rate for Payer: PHCS Commercial |
$467.04
|
| Rate for Payer: United Healthcare All Payer |
$428.12
|
|
|
GUIDEWIRE STEERANT 200 CVD
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
GUIDEWIRE STEERANT 200 CVD
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
GUIDEWIRE STR FIXD COR .025*15
|
Facility
|
IP
|
$161.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$155.28 |
| Rate for Payer: Aetna Commercial |
$124.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.17
|
| Rate for Payer: Cash Price |
$80.88
|
| Rate for Payer: Cigna Commercial |
$134.25
|
| Rate for Payer: First Health Commercial |
$153.66
|
| Rate for Payer: Humana Commercial |
$137.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.34
|
| Rate for Payer: Ohio Health Group HMO |
$121.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.61
|
| Rate for Payer: PHCS Commercial |
$155.28
|
| Rate for Payer: United Healthcare All Payer |
$142.34
|
|
|
GUIDEWIRE STR FIXD COR .025*15
|
Facility
|
OP
|
$161.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$155.28 |
| Rate for Payer: Aetna Commercial |
$124.55
|
| Rate for Payer: Anthem Medicaid |
$55.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.17
|
| Rate for Payer: Cash Price |
$80.88
|
| Rate for Payer: Cigna Commercial |
$134.25
|
| Rate for Payer: First Health Commercial |
$153.66
|
| Rate for Payer: Humana Commercial |
$137.49
|
| Rate for Payer: Humana KY Medicaid |
$55.63
|
| Rate for Payer: Kentucky WC Medicaid |
$56.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.34
|
| Rate for Payer: Ohio Health Group HMO |
$121.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.61
|
| Rate for Payer: PHCS Commercial |
$155.28
|
| Rate for Payer: United Healthcare All Payer |
$142.34
|
|
|
GUIDEWIRE SUREGLIDE ANG .035
|
Facility
|
IP
|
$807.61
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.28 |
| Max. Negotiated Rate |
$775.31 |
| Rate for Payer: Aetna Commercial |
$621.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.94
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$670.32
|
| Rate for Payer: First Health Commercial |
$767.23
|
| Rate for Payer: Humana Commercial |
$686.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.70
|
| Rate for Payer: Ohio Health Group HMO |
$605.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.25
|
| Rate for Payer: PHCS Commercial |
$775.31
|
| Rate for Payer: United Healthcare All Payer |
$710.70
|
|
|
GUIDEWIRE SUREGLIDE ANG .035
|
Facility
|
OP
|
$807.61
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.28 |
| Max. Negotiated Rate |
$775.31 |
| Rate for Payer: Aetna Commercial |
$621.86
|
| Rate for Payer: Anthem Medicaid |
$277.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.94
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$670.32
|
| Rate for Payer: First Health Commercial |
$767.23
|
| Rate for Payer: Humana Commercial |
$686.47
|
| Rate for Payer: Humana KY Medicaid |
$277.74
|
| Rate for Payer: Kentucky WC Medicaid |
$280.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.70
|
| Rate for Payer: Ohio Health Group HMO |
$605.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.25
|
| Rate for Payer: PHCS Commercial |
$775.31
|
| Rate for Payer: United Healthcare All Payer |
$710.70
|
|
|
GUIDEWIRE T2 BALL TIP 3*800MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.70 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,643.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.41
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
GUIDEWIRE T2 BALL TIP 3*800MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.70 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,643.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.41
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
GUIDEWIRE THRD 3.2MM TIP
|
Facility
|
IP
|
$1,206.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.88 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Aetna Commercial |
$928.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.88
|
| Rate for Payer: Cash Price |
$603.12
|
| Rate for Payer: Cigna Commercial |
$1,001.19
|
| Rate for Payer: First Health Commercial |
$1,145.94
|
| Rate for Payer: Humana Commercial |
$1,025.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$989.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.50
|
| Rate for Payer: Ohio Health Group HMO |
$904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,049.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$832.31
|
| Rate for Payer: PHCS Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Payer |
$1,061.50
|
|
|
GUIDEWIRE THRD 3.2MM TIP
|
Facility
|
OP
|
$1,206.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.88 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Aetna Commercial |
$928.81
|
| Rate for Payer: Anthem Medicaid |
$414.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.88
|
| Rate for Payer: Cash Price |
$603.12
|
| Rate for Payer: Cigna Commercial |
$1,001.19
|
| Rate for Payer: First Health Commercial |
$1,145.94
|
| Rate for Payer: Humana Commercial |
$1,025.31
|
| Rate for Payer: Humana KY Medicaid |
$414.83
|
| Rate for Payer: Kentucky WC Medicaid |
$419.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$989.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.50
|
| Rate for Payer: Ohio Health Group HMO |
$904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,049.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$832.31
|
| Rate for Payer: PHCS Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Payer |
$1,061.50
|
|
|
GUIDEWIRE THREADED 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
|
|
