|
GUIDWIR FIXED J CURVE .018*40
|
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 .018*40
|
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 FIXED J CURVE .035*50
|
Facility
|
OP
|
$457.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$439.63 |
| Rate for Payer: Aetna Commercial |
$352.62
|
| Rate for Payer: Anthem Medicaid |
$157.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.20
|
| Rate for Payer: Cash Price |
$228.97
|
| Rate for Payer: Cigna Commercial |
$380.10
|
| Rate for Payer: First Health Commercial |
$435.05
|
| Rate for Payer: Humana Commercial |
$389.26
|
| Rate for Payer: Humana KY Medicaid |
$157.49
|
| Rate for Payer: Kentucky WC Medicaid |
$159.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.00
|
| Rate for Payer: Ohio Health Group HMO |
$343.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.99
|
| Rate for Payer: PHCS Commercial |
$439.63
|
| Rate for Payer: United Healthcare All Payer |
$403.00
|
|
|
GUIDWIR FIXED J CURVE .035*50
|
Facility
|
IP
|
$457.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$439.63 |
| Rate for Payer: Aetna Commercial |
$352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.20
|
| Rate for Payer: Cash Price |
$228.97
|
| Rate for Payer: Cigna Commercial |
$380.10
|
| Rate for Payer: First Health Commercial |
$435.05
|
| Rate for Payer: Humana Commercial |
$389.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.00
|
| Rate for Payer: Ohio Health Group HMO |
$343.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.99
|
| Rate for Payer: PHCS Commercial |
$439.63
|
| Rate for Payer: United Healthcare All Payer |
$403.00
|
|
|
GUIDWIR FX CORE TFE CT .018*15
|
Facility
|
OP
|
$514.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.27 |
| Max. Negotiated Rate |
$493.67 |
| Rate for Payer: Aetna Commercial |
$395.96
|
| Rate for Payer: Anthem Medicaid |
$176.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.11
|
| Rate for Payer: Cash Price |
$257.12
|
| Rate for Payer: Cigna Commercial |
$426.82
|
| Rate for Payer: First Health Commercial |
$488.53
|
| Rate for Payer: Humana Commercial |
$437.10
|
| Rate for Payer: Humana KY Medicaid |
$176.85
|
| Rate for Payer: Kentucky WC Medicaid |
$178.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.53
|
| Rate for Payer: Ohio Health Group HMO |
$385.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.83
|
| Rate for Payer: PHCS Commercial |
$493.67
|
| Rate for Payer: United Healthcare All Payer |
$452.53
|
|
|
GUIDWIR FX CORE TFE CT .018*15
|
Facility
|
IP
|
$514.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.27 |
| Max. Negotiated Rate |
$493.67 |
| Rate for Payer: Aetna Commercial |
$395.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.11
|
| Rate for Payer: Cash Price |
$257.12
|
| Rate for Payer: Cigna Commercial |
$426.82
|
| Rate for Payer: First Health Commercial |
$488.53
|
| Rate for Payer: Humana Commercial |
$437.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.53
|
| Rate for Payer: Ohio Health Group HMO |
$385.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.83
|
| Rate for Payer: PHCS Commercial |
$493.67
|
| Rate for Payer: United Healthcare All Payer |
$452.53
|
|
|
GUIDWIR HYDROPHILIC .018*260 S
|
Facility
|
OP
|
$1,579.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.77 |
| Max. Negotiated Rate |
$1,516.07 |
| Rate for Payer: Aetna Commercial |
$1,216.01
|
| Rate for Payer: Anthem Medicaid |
$543.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,231.81
|
| Rate for Payer: Cash Price |
$789.62
|
| Rate for Payer: Cigna Commercial |
$1,310.77
|
| Rate for Payer: First Health Commercial |
$1,500.28
|
| Rate for Payer: Humana Commercial |
$1,342.35
|
| Rate for Payer: Humana KY Medicaid |
$543.10
|
| Rate for Payer: Kentucky WC Medicaid |
$548.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,165.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,389.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,184.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,263.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,373.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.68
|
| Rate for Payer: PHCS Commercial |
$1,516.07
|
| Rate for Payer: United Healthcare All Payer |
$1,389.73
|
|
|
GUIDWIR HYDROPHILIC .018*260 S
|
Facility
|
IP
|
$1,579.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.77 |
| Max. Negotiated Rate |
$1,516.07 |
| Rate for Payer: Aetna Commercial |
$1,216.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,231.81
|
| Rate for Payer: Cash Price |
$789.62
|
| Rate for Payer: Cigna Commercial |
$1,310.77
|
| Rate for Payer: First Health Commercial |
$1,500.28
|
| Rate for Payer: Humana Commercial |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,294.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,165.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,389.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,184.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,263.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,373.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.68
|
| Rate for Payer: PHCS Commercial |
$1,516.07
|
| Rate for Payer: United Healthcare All Payer |
$1,389.73
|
|
|
GUIDWIR MAGIC TORQUE .035*180
|
Facility
|
OP
|
$1,140.42
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$342.13 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$878.12
|
| Rate for Payer: Anthem Medicaid |
$392.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.53
|
| Rate for Payer: Cash Price |
$570.21
|
| Rate for Payer: Cigna Commercial |
$946.55
|
| Rate for Payer: First Health Commercial |
$1,083.40
|
| Rate for Payer: Humana Commercial |
$969.36
|
| Rate for Payer: Humana KY Medicaid |
$392.19
|
| Rate for Payer: Kentucky WC Medicaid |
$396.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$935.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$400.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.57
|
| Rate for Payer: Ohio Health Group HMO |
$855.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$992.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.89
|
| Rate for Payer: PHCS Commercial |
$1,094.80
|
| Rate for Payer: United Healthcare All Payer |
$1,003.57
|
|
|
GUIDWIR MAGIC TORQUE .035*180
|
Facility
|
IP
|
$1,140.42
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$342.13 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$878.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.53
|
| Rate for Payer: Cash Price |
$570.21
|
| Rate for Payer: Cigna Commercial |
$946.55
|
| Rate for Payer: First Health Commercial |
$1,083.40
|
| Rate for Payer: Humana Commercial |
$969.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$935.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.57
|
| Rate for Payer: Ohio Health Group HMO |
$855.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$992.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.89
|
| Rate for Payer: PHCS Commercial |
$1,094.80
|
| Rate for Payer: United Healthcare All Payer |
$1,003.57
|
|
|
GUIDWIR NTHD SPADE PT 2.0*230M
|
Facility
|
OP
|
$795.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.66 |
| Max. Negotiated Rate |
$763.73 |
| Rate for Payer: Aetna Commercial |
$612.57
|
| Rate for Payer: Anthem Medicaid |
$273.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.53
|
| Rate for Payer: Cash Price |
$397.78
|
| Rate for Payer: Cigna Commercial |
$660.31
|
| Rate for Payer: First Health Commercial |
$755.77
|
| Rate for Payer: Humana Commercial |
$676.22
|
| Rate for Payer: Humana KY Medicaid |
$273.59
|
| Rate for Payer: Kentucky WC Medicaid |
$276.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.08
|
| Rate for Payer: Ohio Health Group HMO |
$596.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.93
|
| Rate for Payer: PHCS Commercial |
$763.73
|
| Rate for Payer: United Healthcare All Payer |
$700.08
|
|
|
GUIDWIR NTHD SPADE PT 2.0*230M
|
Facility
|
IP
|
$795.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.66 |
| Max. Negotiated Rate |
$763.73 |
| Rate for Payer: Aetna Commercial |
$612.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.53
|
| Rate for Payer: Cash Price |
$397.78
|
| Rate for Payer: Cigna Commercial |
$660.31
|
| Rate for Payer: First Health Commercial |
$755.77
|
| Rate for Payer: Humana Commercial |
$676.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.08
|
| Rate for Payer: Ohio Health Group HMO |
$596.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.93
|
| Rate for Payer: PHCS Commercial |
$763.73
|
| Rate for Payer: United Healthcare All Payer |
$700.08
|
|
|
GUIDWIR SHT TAPR .018*190 J1.5
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
GUIDWIR SHT TAPR .018*190 J1.5
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
GUIDWIR SM VESSEL .025*150 STR
|
Facility
|
OP
|
$822.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$789.20 |
| Rate for Payer: Aetna Commercial |
$633.00
|
| Rate for Payer: Anthem Medicaid |
$282.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.22
|
| Rate for Payer: Cash Price |
$411.04
|
| Rate for Payer: Cigna Commercial |
$682.33
|
| Rate for Payer: First Health Commercial |
$780.98
|
| Rate for Payer: Humana Commercial |
$698.77
|
| Rate for Payer: Humana KY Medicaid |
$282.71
|
| Rate for Payer: Kentucky WC Medicaid |
$285.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.43
|
| Rate for Payer: Ohio Health Group HMO |
$616.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.24
|
| Rate for Payer: PHCS Commercial |
$789.20
|
| Rate for Payer: United Healthcare All Payer |
$723.43
|
|
|
GUIDWIR SM VESSEL .025*150 STR
|
Facility
|
IP
|
$822.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$789.20 |
| Rate for Payer: Aetna Commercial |
$633.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.22
|
| Rate for Payer: Cash Price |
$411.04
|
| Rate for Payer: Cigna Commercial |
$682.33
|
| Rate for Payer: First Health Commercial |
$780.98
|
| Rate for Payer: Humana Commercial |
$698.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.43
|
| Rate for Payer: Ohio Health Group HMO |
$616.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.24
|
| Rate for Payer: PHCS Commercial |
$789.20
|
| Rate for Payer: United Healthcare All Payer |
$723.43
|
|
|
GUIDWIR W/TROCR TIP DIA 1.35MM
|
Facility
|
IP
|
$471.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GUIDWIR W/TROCR TIP DIA 1.35MM
|
Facility
|
OP
|
$471.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GUNTHER TULIP VENA CAVA FILTER
|
Facility
|
IP
|
$6,996.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.03 |
| Max. Negotiated Rate |
$6,716.88 |
| Rate for Payer: Aetna Commercial |
$5,387.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.47
|
| Rate for Payer: Cash Price |
$3,498.38
|
| Rate for Payer: Cigna Commercial |
$5,807.30
|
| Rate for Payer: First Health Commercial |
$6,646.91
|
| Rate for Payer: Humana Commercial |
$5,947.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,597.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,087.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,827.76
|
| Rate for Payer: PHCS Commercial |
$6,716.88
|
| Rate for Payer: United Healthcare All Payer |
$6,157.14
|
|
|
GUNTHER TULIP VENA CAVA FILTER
|
Facility
|
OP
|
$6,996.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.03 |
| Max. Negotiated Rate |
$6,716.88 |
| Rate for Payer: Aetna Commercial |
$5,387.50
|
| Rate for Payer: Anthem Medicaid |
$2,406.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.47
|
| Rate for Payer: Cash Price |
$3,498.38
|
| Rate for Payer: Cigna Commercial |
$5,807.30
|
| Rate for Payer: First Health Commercial |
$6,646.91
|
| Rate for Payer: Humana Commercial |
$5,947.24
|
| Rate for Payer: Humana KY Medicaid |
$2,406.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,597.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,087.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,827.76
|
| Rate for Payer: PHCS Commercial |
$6,716.88
|
| Rate for Payer: United Healthcare All Payer |
$6,157.14
|
|
|
GYNE LOTRIMIN(CLOTRIM) 1% 45GM
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 61269022041
|
| Hospital Charge Code |
25000742
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Anthem Medicaid |
$0.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.47
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: First Health Commercial |
$0.57
|
| Rate for Payer: Humana Commercial |
$0.51
|
| Rate for Payer: Humana KY Medicaid |
$0.21
|
| Rate for Payer: Kentucky WC Medicaid |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.53
|
| Rate for Payer: Ohio Health Group HMO |
$0.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.41
|
| Rate for Payer: PHCS Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Payer |
$0.53
|
|
|
GYNE LOTRIMIN(CLOTRIM) 1% 45GM
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 61269022041
|
| Hospital Charge Code |
25000742
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.47
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: First Health Commercial |
$0.57
|
| Rate for Payer: Humana Commercial |
$0.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.53
|
| Rate for Payer: Ohio Health Group HMO |
$0.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.41
|
| Rate for Payer: PHCS Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Payer |
$0.53
|
|
|
HALAVEN 0.1MG(1MG/2ML VIA;)
|
Facility
|
OP
|
$7,684.50
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
25002610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$7,377.12 |
| Rate for Payer: Aetna Commercial |
$5,917.06
|
| Rate for Payer: Anthem Medicaid |
$2,642.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$104.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$146.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.18
|
| Rate for Payer: Cash Price |
$3,842.25
|
| Rate for Payer: Cash Price |
$3,842.25
|
| Rate for Payer: Cigna Commercial |
$6,378.14
|
| Rate for Payer: First Health Commercial |
$7,300.27
|
| Rate for Payer: Humana Commercial |
$6,531.82
|
| Rate for Payer: Humana KY Medicaid |
$2,642.70
|
| Rate for Payer: Humana Medicare Advantage |
$104.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,301.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,671.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,762.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,763.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,147.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,685.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,302.31
|
| Rate for Payer: PHCS Commercial |
$7,377.12
|
| Rate for Payer: United Healthcare All Payer |
$6,762.36
|
|
|
HALAVEN 0.1MG(1MG/2ML VIA;)
|
Facility
|
IP
|
$7,684.50
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
25002610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,305.35 |
| Max. Negotiated Rate |
$7,377.12 |
| Rate for Payer: Aetna Commercial |
$5,917.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.91
|
| Rate for Payer: Cash Price |
$3,842.25
|
| Rate for Payer: Cigna Commercial |
$6,378.14
|
| Rate for Payer: First Health Commercial |
$7,300.27
|
| Rate for Payer: Humana Commercial |
$6,531.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,301.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,671.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,762.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,763.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,147.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,685.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,302.31
|
| Rate for Payer: PHCS Commercial |
$7,377.12
|
| Rate for Payer: United Healthcare All Payer |
$6,762.36
|
|
|
HALDOL 10MG/5ML ORAL SUSP
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Anthem Medicaid |
$1.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$3.99
|
| Rate for Payer: Humana Commercial |
$3.57
|
| Rate for Payer: Humana KY Medicaid |
$1.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
