|
GUIDEZILLA 6FR
|
Facility
|
OP
|
$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 Medicaid |
$1,203.65
|
| 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: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| 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: Molina Healthcare Medicaid |
$1,227.80
|
| 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
|
|
|
GUIDWIR ATTAIN HYBRD GWR419588
|
Facility
|
IP
|
$1,881.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.42 |
| Max. Negotiated Rate |
$1,806.14 |
| Rate for Payer: Aetna Commercial |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.49
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cigna Commercial |
$1,561.56
|
| Rate for Payer: First Health Commercial |
$1,787.33
|
| Rate for Payer: Humana Commercial |
$1,599.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.17
|
| Rate for Payer: PHCS Commercial |
$1,806.14
|
| Rate for Payer: United Healthcare All Payer |
$1,655.63
|
|
|
GUIDWIR ATTAIN HYBRD GWR419588
|
Facility
|
OP
|
$1,881.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.42 |
| Max. Negotiated Rate |
$1,806.14 |
| Rate for Payer: Aetna Commercial |
$1,448.68
|
| Rate for Payer: Anthem Medicaid |
$647.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.49
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cigna Commercial |
$1,561.56
|
| Rate for Payer: First Health Commercial |
$1,787.33
|
| Rate for Payer: Humana Commercial |
$1,599.19
|
| Rate for Payer: Humana KY Medicaid |
$647.01
|
| Rate for Payer: Kentucky WC Medicaid |
$653.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.17
|
| Rate for Payer: PHCS Commercial |
$1,806.14
|
| Rate for Payer: United Healthcare All Payer |
$1,655.63
|
|
|
GUIDWIR ATTAIN HYBRD GWR419688
|
Facility
|
IP
|
$1,881.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.42 |
| Max. Negotiated Rate |
$1,806.14 |
| Rate for Payer: Aetna Commercial |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.49
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cigna Commercial |
$1,561.56
|
| Rate for Payer: First Health Commercial |
$1,787.33
|
| Rate for Payer: Humana Commercial |
$1,599.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.17
|
| Rate for Payer: PHCS Commercial |
$1,806.14
|
| Rate for Payer: United Healthcare All Payer |
$1,655.63
|
|
|
GUIDWIR ATTAIN HYBRD GWR419688
|
Facility
|
OP
|
$1,881.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.42 |
| Max. Negotiated Rate |
$1,806.14 |
| Rate for Payer: Aetna Commercial |
$1,448.68
|
| Rate for Payer: Anthem Medicaid |
$647.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.49
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cigna Commercial |
$1,561.56
|
| Rate for Payer: First Health Commercial |
$1,787.33
|
| Rate for Payer: Humana Commercial |
$1,599.19
|
| Rate for Payer: Humana KY Medicaid |
$647.01
|
| Rate for Payer: Kentucky WC Medicaid |
$653.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.17
|
| Rate for Payer: PHCS Commercial |
$1,806.14
|
| Rate for Payer: United Healthcare All Payer |
$1,655.63
|
|
|
GUIDWIR ATTAIN HYBRID MEDTRONI
|
Facility
|
OP
|
$1,881.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.42 |
| Max. Negotiated Rate |
$1,806.14 |
| Rate for Payer: Aetna Commercial |
$1,448.68
|
| Rate for Payer: Anthem Medicaid |
$647.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.49
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cigna Commercial |
$1,561.56
|
| Rate for Payer: First Health Commercial |
$1,787.33
|
| Rate for Payer: Humana Commercial |
$1,599.19
|
| Rate for Payer: Humana KY Medicaid |
$647.01
|
| Rate for Payer: Kentucky WC Medicaid |
$653.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.17
|
| Rate for Payer: PHCS Commercial |
$1,806.14
|
| Rate for Payer: United Healthcare All Payer |
$1,655.63
|
|
|
GUIDWIR ATTAIN HYBRID MEDTRONI
|
Facility
|
IP
|
$1,881.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.42 |
| Max. Negotiated Rate |
$1,806.14 |
| Rate for Payer: Aetna Commercial |
$1,448.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.49
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cigna Commercial |
$1,561.56
|
| Rate for Payer: First Health Commercial |
$1,787.33
|
| Rate for Payer: Humana Commercial |
$1,599.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,636.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.17
|
| Rate for Payer: PHCS Commercial |
$1,806.14
|
| Rate for Payer: United Healthcare All Payer |
$1,655.63
|
|
|
GUIDWIR DBL FLEX .025*80CM STR
|
Facility
|
OP
|
$525.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$504.30 |
| Rate for Payer: Aetna Commercial |
$404.49
|
| Rate for Payer: Anthem Medicaid |
$180.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.74
|
| Rate for Payer: Cash Price |
$262.66
|
| Rate for Payer: Cigna Commercial |
$436.01
|
| Rate for Payer: First Health Commercial |
$499.04
|
| Rate for Payer: Humana Commercial |
$446.51
|
| Rate for Payer: Humana KY Medicaid |
$180.65
|
| Rate for Payer: Kentucky WC Medicaid |
$182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.27
|
| Rate for Payer: Ohio Health Group HMO |
$393.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.46
|
| Rate for Payer: PHCS Commercial |
$504.30
|
| Rate for Payer: United Healthcare All Payer |
$462.27
|
|
|
GUIDWIR DBL FLEX .025*80CM STR
|
Facility
|
IP
|
$525.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$504.30 |
| Rate for Payer: Aetna Commercial |
$404.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.74
|
| Rate for Payer: Cash Price |
$262.66
|
| Rate for Payer: Cigna Commercial |
$436.01
|
| Rate for Payer: First Health Commercial |
$499.04
|
| Rate for Payer: Humana Commercial |
$446.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.27
|
| Rate for Payer: Ohio Health Group HMO |
$393.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.46
|
| Rate for Payer: PHCS Commercial |
$504.30
|
| Rate for Payer: United Healthcare All Payer |
$462.27
|
|
|
GUIDWIR DBL FLEX CTD .018*50CM
|
Facility
|
IP
|
$566.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.91 |
| Max. Negotiated Rate |
$543.70 |
| Rate for Payer: Aetna Commercial |
$436.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.75
|
| Rate for Payer: Cash Price |
$283.18
|
| Rate for Payer: Cigna Commercial |
$470.07
|
| Rate for Payer: First Health Commercial |
$538.03
|
| Rate for Payer: Humana Commercial |
$481.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.39
|
| Rate for Payer: Ohio Health Group HMO |
$424.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.78
|
| Rate for Payer: PHCS Commercial |
$543.70
|
| Rate for Payer: United Healthcare All Payer |
$498.39
|
|
|
GUIDWIR DBL FLEX CTD .018*50CM
|
Facility
|
OP
|
$566.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.91 |
| Max. Negotiated Rate |
$543.70 |
| Rate for Payer: Aetna Commercial |
$436.09
|
| Rate for Payer: Anthem Medicaid |
$194.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.75
|
| Rate for Payer: Cash Price |
$283.18
|
| Rate for Payer: Cigna Commercial |
$470.07
|
| Rate for Payer: First Health Commercial |
$538.03
|
| Rate for Payer: Humana Commercial |
$481.40
|
| Rate for Payer: Humana KY Medicaid |
$194.77
|
| Rate for Payer: Kentucky WC Medicaid |
$196.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.39
|
| Rate for Payer: Ohio Health Group HMO |
$424.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.78
|
| Rate for Payer: PHCS Commercial |
$543.70
|
| Rate for Payer: United Healthcare All Payer |
$498.39
|
|
|
GUIDWIR DBL FLX HEP CT .018*50
|
Facility
|
OP
|
$786.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.91 |
| Max. Negotiated Rate |
$754.90 |
| Rate for Payer: Aetna Commercial |
$605.49
|
| Rate for Payer: Anthem Medicaid |
$270.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.35
|
| Rate for Payer: Cash Price |
$393.18
|
| Rate for Payer: Cigna Commercial |
$652.67
|
| Rate for Payer: First Health Commercial |
$747.03
|
| Rate for Payer: Humana Commercial |
$668.40
|
| Rate for Payer: Humana KY Medicaid |
$270.43
|
| Rate for Payer: Kentucky WC Medicaid |
$273.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.99
|
| Rate for Payer: Ohio Health Group HMO |
$589.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.58
|
| Rate for Payer: PHCS Commercial |
$754.90
|
| Rate for Payer: United Healthcare All Payer |
$691.99
|
|
|
GUIDWIR DBL FLX HEP CT .018*50
|
Facility
|
IP
|
$786.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.91 |
| Max. Negotiated Rate |
$754.90 |
| Rate for Payer: Aetna Commercial |
$605.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.35
|
| Rate for Payer: Cash Price |
$393.18
|
| Rate for Payer: Cigna Commercial |
$652.67
|
| Rate for Payer: First Health Commercial |
$747.03
|
| Rate for Payer: Humana Commercial |
$668.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.99
|
| Rate for Payer: Ohio Health Group HMO |
$589.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.58
|
| Rate for Payer: PHCS Commercial |
$754.90
|
| Rate for Payer: United Healthcare All Payer |
$691.99
|
|
|
GUIDWIRE TOURGUIDE 6.5F 45*17M
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 45*17M
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 45*9MM
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 45*9MM
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 55*17M
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 55*17M
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 55*9MM
|
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
|
|
|
GUIDWIRE TOURGUIDE 6.5F 55*9MM
|
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
|
|
|
GUIDWIR FIXED HEP CTD .035*40
|
Facility
|
IP
|
$496.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.91 |
| Max. Negotiated Rate |
$476.51 |
| Rate for Payer: Aetna Commercial |
$382.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.16
|
| Rate for Payer: Cash Price |
$248.18
|
| Rate for Payer: Cigna Commercial |
$411.98
|
| Rate for Payer: First Health Commercial |
$471.54
|
| Rate for Payer: Humana Commercial |
$421.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.80
|
| Rate for Payer: Ohio Health Group HMO |
$372.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.49
|
| Rate for Payer: PHCS Commercial |
$476.51
|
| Rate for Payer: United Healthcare All Payer |
$436.80
|
|
|
GUIDWIR FIXED HEP CTD .035*40
|
Facility
|
OP
|
$496.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.91 |
| Max. Negotiated Rate |
$476.51 |
| Rate for Payer: Aetna Commercial |
$382.20
|
| Rate for Payer: Anthem Medicaid |
$170.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.16
|
| Rate for Payer: Cash Price |
$248.18
|
| Rate for Payer: Cigna Commercial |
$411.98
|
| Rate for Payer: First Health Commercial |
$471.54
|
| Rate for Payer: Humana Commercial |
$421.91
|
| Rate for Payer: Humana KY Medicaid |
$170.70
|
| Rate for Payer: Kentucky WC Medicaid |
$172.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.80
|
| Rate for Payer: Ohio Health Group HMO |
$372.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.49
|
| Rate for Payer: PHCS Commercial |
$476.51
|
| Rate for Payer: United Healthcare All Payer |
$436.80
|
|
|
GUIDWIR FIXED J CURVE .015*30
|
Facility
|
OP
|
$525.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$504.30 |
| Rate for Payer: Aetna Commercial |
$404.49
|
| Rate for Payer: Anthem Medicaid |
$180.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.74
|
| Rate for Payer: Cash Price |
$262.66
|
| Rate for Payer: Cigna Commercial |
$436.01
|
| Rate for Payer: First Health Commercial |
$499.04
|
| Rate for Payer: Humana Commercial |
$446.51
|
| Rate for Payer: Humana KY Medicaid |
$180.65
|
| Rate for Payer: Kentucky WC Medicaid |
$182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.27
|
| Rate for Payer: Ohio Health Group HMO |
$393.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.46
|
| Rate for Payer: PHCS Commercial |
$504.30
|
| Rate for Payer: United Healthcare All Payer |
$462.27
|
|
|
GUIDWIR FIXED J CURVE .015*30
|
Facility
|
IP
|
$525.31
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$504.30 |
| Rate for Payer: Aetna Commercial |
$404.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.74
|
| Rate for Payer: Cash Price |
$262.66
|
| Rate for Payer: Cigna Commercial |
$436.01
|
| Rate for Payer: First Health Commercial |
$499.04
|
| Rate for Payer: Humana Commercial |
$446.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.27
|
| Rate for Payer: Ohio Health Group HMO |
$393.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.46
|
| Rate for Payer: PHCS Commercial |
$504.30
|
| Rate for Payer: United Healthcare All Payer |
$462.27
|
|
