|
GUIDEWIRE TOURGUIDE 8.5F 45*17
|
Facility
|
IP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 45*17
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 45*22
|
Facility
|
IP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 45*22
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 55*17
|
Facility
|
IP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 55*17
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 55*22
|
Facility
|
OP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem Medicaid |
$1,474.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Humana KY Medicaid |
$1,474.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,489.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TOURGUIDE 8.5F 55*22
|
Facility
|
IP
|
$4,287.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$4,116.00 |
| Rate for Payer: Aetna Commercial |
$3,301.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,344.25
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: Cigna Commercial |
$3,558.62
|
| Rate for Payer: First Health Commercial |
$4,073.12
|
| Rate for Payer: Humana Commercial |
$3,644.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,515.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,164.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,215.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,958.38
|
| Rate for Payer: PHCS Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Payer |
$3,773.00
|
|
|
GUIDEWIRE TROCAR TIP 1.35MM
|
Facility
|
IP
|
$506.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.03 |
| Max. Negotiated Rate |
$486.48 |
| Rate for Payer: Aetna Commercial |
$390.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.26
|
| Rate for Payer: Cash Price |
$253.38
|
| Rate for Payer: Cigna Commercial |
$420.60
|
| Rate for Payer: First Health Commercial |
$481.41
|
| Rate for Payer: Humana Commercial |
$430.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.94
|
| Rate for Payer: Ohio Health Group HMO |
$380.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.66
|
| Rate for Payer: PHCS Commercial |
$486.48
|
| Rate for Payer: United Healthcare All Payer |
$445.94
|
|
|
GUIDEWIRE TROCAR TIP 1.35MM
|
Facility
|
OP
|
$506.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.03 |
| Max. Negotiated Rate |
$486.48 |
| Rate for Payer: Aetna Commercial |
$390.20
|
| Rate for Payer: Anthem Medicaid |
$174.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.26
|
| Rate for Payer: Cash Price |
$253.38
|
| Rate for Payer: Cigna Commercial |
$420.60
|
| Rate for Payer: First Health Commercial |
$481.41
|
| Rate for Payer: Humana Commercial |
$430.74
|
| Rate for Payer: Humana KY Medicaid |
$174.27
|
| Rate for Payer: Kentucky WC Medicaid |
$176.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.94
|
| Rate for Payer: Ohio Health Group HMO |
$380.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.66
|
| Rate for Payer: PHCS Commercial |
$486.48
|
| Rate for Payer: United Healthcare All Payer |
$445.94
|
|
|
GUIDE WIRE TROCAR TIP 3.0 X
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
GUIDE WIRE TROCAR TIP 3.0 X
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
GUIDEWIRE TRO TIP 2MM AR-8956K
|
Facility
|
IP
|
$533.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.12 |
| Max. Negotiated Rate |
$512.40 |
| Rate for Payer: Aetna Commercial |
$410.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.32
|
| Rate for Payer: Cash Price |
$266.88
|
| Rate for Payer: Cigna Commercial |
$443.01
|
| Rate for Payer: First Health Commercial |
$507.06
|
| Rate for Payer: Humana Commercial |
$453.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.70
|
| Rate for Payer: Ohio Health Group HMO |
$400.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.29
|
| Rate for Payer: PHCS Commercial |
$512.40
|
| Rate for Payer: United Healthcare All Payer |
$469.70
|
|
|
GUIDEWIRE TRO TIP 2MM AR-8956K
|
Facility
|
OP
|
$533.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.12 |
| Max. Negotiated Rate |
$512.40 |
| Rate for Payer: Aetna Commercial |
$410.99
|
| Rate for Payer: Anthem Medicaid |
$183.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.32
|
| Rate for Payer: Cash Price |
$266.88
|
| Rate for Payer: Cigna Commercial |
$443.01
|
| Rate for Payer: First Health Commercial |
$507.06
|
| Rate for Payer: Humana Commercial |
$453.69
|
| Rate for Payer: Humana KY Medicaid |
$183.56
|
| Rate for Payer: Kentucky WC Medicaid |
$185.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.70
|
| Rate for Payer: Ohio Health Group HMO |
$400.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.29
|
| Rate for Payer: PHCS Commercial |
$512.40
|
| Rate for Payer: United Healthcare All Payer |
$469.70
|
|
|
GUIDEWIRE VNUS .025*260CM
|
Facility
|
IP
|
$486.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.91 |
| Max. Negotiated Rate |
$466.91 |
| Rate for Payer: Aetna Commercial |
$374.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.36
|
| Rate for Payer: Cash Price |
$243.18
|
| Rate for Payer: Cigna Commercial |
$403.68
|
| Rate for Payer: First Health Commercial |
$462.04
|
| Rate for Payer: Humana Commercial |
$413.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.00
|
| Rate for Payer: Ohio Health Group HMO |
$364.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.59
|
| Rate for Payer: PHCS Commercial |
$466.91
|
| Rate for Payer: United Healthcare All Payer |
$428.00
|
|
|
GUIDEWIRE VNUS .025*260CM
|
Facility
|
OP
|
$486.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.91 |
| Max. Negotiated Rate |
$466.91 |
| Rate for Payer: Aetna Commercial |
$374.50
|
| Rate for Payer: Anthem Medicaid |
$167.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.36
|
| Rate for Payer: Cash Price |
$243.18
|
| Rate for Payer: Cigna Commercial |
$403.68
|
| Rate for Payer: First Health Commercial |
$462.04
|
| Rate for Payer: Humana Commercial |
$413.41
|
| Rate for Payer: Humana KY Medicaid |
$167.26
|
| Rate for Payer: Kentucky WC Medicaid |
$168.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.00
|
| Rate for Payer: Ohio Health Group HMO |
$364.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.59
|
| Rate for Payer: PHCS Commercial |
$466.91
|
| Rate for Payer: United Healthcare All Payer |
$428.00
|
|
|
GUIDEWIRE W/TROCAR TIP .043
|
Facility
|
IP
|
$471.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Aetna Commercial |
$362.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.62
|
| Rate for Payer: Cash Price |
$235.66
|
| Rate for Payer: Cigna Commercial |
$391.19
|
| Rate for Payer: First Health Commercial |
$447.74
|
| Rate for Payer: Humana Commercial |
$400.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.75
|
| Rate for Payer: Ohio Health Group HMO |
$353.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.20
|
| Rate for Payer: PHCS Commercial |
$452.46
|
| Rate for Payer: United Healthcare All Payer |
$414.75
|
|
|
GUIDEWIRE W/TROCAR TIP .043
|
Facility
|
OP
|
$471.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Aetna Commercial |
$362.91
|
| Rate for Payer: Anthem Medicaid |
$162.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.62
|
| Rate for Payer: Cash Price |
$235.66
|
| Rate for Payer: Cigna Commercial |
$391.19
|
| Rate for Payer: First Health Commercial |
$447.74
|
| Rate for Payer: Humana Commercial |
$400.61
|
| Rate for Payer: Humana KY Medicaid |
$162.08
|
| Rate for Payer: Kentucky WC Medicaid |
$163.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.75
|
| Rate for Payer: Ohio Health Group HMO |
$353.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.20
|
| Rate for Payer: PHCS Commercial |
$452.46
|
| Rate for Payer: United Healthcare All Payer |
$414.75
|
|
|
GUIDEWIRE W/TROCAR TIP .062
|
Facility
|
OP
|
$471.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Aetna Commercial |
$362.91
|
| Rate for Payer: Anthem Medicaid |
$162.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.62
|
| Rate for Payer: Cash Price |
$235.66
|
| Rate for Payer: Cigna Commercial |
$391.19
|
| Rate for Payer: First Health Commercial |
$447.74
|
| Rate for Payer: Humana Commercial |
$400.61
|
| Rate for Payer: Humana KY Medicaid |
$162.08
|
| Rate for Payer: Kentucky WC Medicaid |
$163.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.75
|
| Rate for Payer: Ohio Health Group HMO |
$353.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.20
|
| Rate for Payer: PHCS Commercial |
$452.46
|
| Rate for Payer: United Healthcare All Payer |
$414.75
|
|
|
GUIDEWIRE W/TROCAR TIP .062
|
Facility
|
IP
|
$471.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$452.46 |
| Rate for Payer: Aetna Commercial |
$362.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.62
|
| Rate for Payer: Cash Price |
$235.66
|
| Rate for Payer: Cigna Commercial |
$391.19
|
| Rate for Payer: First Health Commercial |
$447.74
|
| Rate for Payer: Humana Commercial |
$400.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.75
|
| Rate for Payer: Ohio Health Group HMO |
$353.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.20
|
| Rate for Payer: PHCS Commercial |
$452.46
|
| Rate for Payer: United Healthcare All Payer |
$414.75
|
|
|
GUIDEWIRE W/TRO TIP .078*5.91
|
Facility
|
OP
|
$432.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$415.20 |
| Rate for Payer: Aetna Commercial |
$333.02
|
| Rate for Payer: Anthem Medicaid |
$148.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.35
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna Commercial |
$358.98
|
| Rate for Payer: First Health Commercial |
$410.88
|
| Rate for Payer: Humana Commercial |
$367.62
|
| Rate for Payer: Humana KY Medicaid |
$148.74
|
| Rate for Payer: Kentucky WC Medicaid |
$150.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.60
|
| Rate for Payer: Ohio Health Group HMO |
$324.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.43
|
| Rate for Payer: PHCS Commercial |
$415.20
|
| Rate for Payer: United Healthcare All Payer |
$380.60
|
|
|
GUIDEWIRE W/TRO TIP .078*5.91
|
Facility
|
IP
|
$432.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$415.20 |
| Rate for Payer: Aetna Commercial |
$333.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$337.35
|
| Rate for Payer: Cash Price |
$216.25
|
| Rate for Payer: Cigna Commercial |
$358.98
|
| Rate for Payer: First Health Commercial |
$410.88
|
| Rate for Payer: Humana Commercial |
$367.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$319.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.60
|
| Rate for Payer: Ohio Health Group HMO |
$324.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.43
|
| Rate for Payer: PHCS Commercial |
$415.20
|
| Rate for Payer: United Healthcare All Payer |
$380.60
|
|
|
GUIDEWIRE ZMS 2.4MM*100CM
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
GUIDEWIRE ZMS 2.4MM*100CM
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
GUIDEZILLA 6FR
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
