|
WIGGLE WIRE 300CM
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
WIGGLE WIRE 300CM
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
WIRE 1.1MM PROV FIXATION 6MM
|
Facility
|
IP
|
$1,713.47
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$1,644.93 |
| Rate for Payer: Aetna Commercial |
$1,319.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.51
|
| Rate for Payer: Cash Price |
$856.74
|
| Rate for Payer: Cigna Commercial |
$1,422.18
|
| Rate for Payer: First Health Commercial |
$1,627.80
|
| Rate for Payer: Humana Commercial |
$1,456.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.18
|
| Rate for Payer: PHCS Commercial |
$1,644.93
|
| Rate for Payer: United Healthcare All Payer |
$1,507.85
|
|
|
WIRE 1.1MM PROV FIXATION 6MM
|
Facility
|
OP
|
$1,713.47
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$1,644.93 |
| Rate for Payer: Aetna Commercial |
$1,319.37
|
| Rate for Payer: Anthem Medicaid |
$589.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.51
|
| Rate for Payer: Cash Price |
$856.74
|
| Rate for Payer: Cigna Commercial |
$1,422.18
|
| Rate for Payer: First Health Commercial |
$1,627.80
|
| Rate for Payer: Humana Commercial |
$1,456.45
|
| Rate for Payer: Humana KY Medicaid |
$589.26
|
| Rate for Payer: Kentucky WC Medicaid |
$595.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$601.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.18
|
| Rate for Payer: PHCS Commercial |
$1,644.93
|
| Rate for Payer: United Healthcare All Payer |
$1,507.85
|
|
|
WIRE 1.5MM PROV FIXATION LONG
|
Facility
|
IP
|
$1,701.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.23 |
| Max. Negotiated Rate |
$1,633.68 |
| Rate for Payer: Aetna Commercial |
$1,310.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.36
|
| Rate for Payer: Cash Price |
$850.88
|
| Rate for Payer: Cigna Commercial |
$1,412.45
|
| Rate for Payer: First Health Commercial |
$1,616.66
|
| Rate for Payer: Humana Commercial |
$1,446.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.54
|
| Rate for Payer: PHCS Commercial |
$1,633.68
|
| Rate for Payer: United Healthcare All Payer |
$1,497.54
|
|
|
WIRE 1.5MM PROV FIXATION LONG
|
Facility
|
OP
|
$1,701.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.23 |
| Max. Negotiated Rate |
$1,633.68 |
| Rate for Payer: Aetna Commercial |
$1,310.35
|
| Rate for Payer: Anthem Medicaid |
$585.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.36
|
| Rate for Payer: Cash Price |
$850.88
|
| Rate for Payer: Cigna Commercial |
$1,412.45
|
| Rate for Payer: First Health Commercial |
$1,616.66
|
| Rate for Payer: Humana Commercial |
$1,446.49
|
| Rate for Payer: Humana KY Medicaid |
$585.23
|
| Rate for Payer: Kentucky WC Medicaid |
$591.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.54
|
| Rate for Payer: PHCS Commercial |
$1,633.68
|
| Rate for Payer: United Healthcare All Payer |
$1,497.54
|
|
|
WIRE 1.5MM PROV FIXATION SHORT
|
Facility
|
OP
|
$1,701.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.23 |
| Max. Negotiated Rate |
$1,633.68 |
| Rate for Payer: Aetna Commercial |
$1,310.35
|
| Rate for Payer: Anthem Medicaid |
$585.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.36
|
| Rate for Payer: Cash Price |
$850.88
|
| Rate for Payer: Cigna Commercial |
$1,412.45
|
| Rate for Payer: First Health Commercial |
$1,616.66
|
| Rate for Payer: Humana Commercial |
$1,446.49
|
| Rate for Payer: Humana KY Medicaid |
$585.23
|
| Rate for Payer: Kentucky WC Medicaid |
$591.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.54
|
| Rate for Payer: PHCS Commercial |
$1,633.68
|
| Rate for Payer: United Healthcare All Payer |
$1,497.54
|
|
|
WIRE 1.5MM PROV FIXATION SHORT
|
Facility
|
IP
|
$1,701.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.23 |
| Max. Negotiated Rate |
$1,633.68 |
| Rate for Payer: Aetna Commercial |
$1,310.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.36
|
| Rate for Payer: Cash Price |
$850.88
|
| Rate for Payer: Cigna Commercial |
$1,412.45
|
| Rate for Payer: First Health Commercial |
$1,616.66
|
| Rate for Payer: Humana Commercial |
$1,446.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.54
|
| Rate for Payer: PHCS Commercial |
$1,633.68
|
| Rate for Payer: United Healthcare All Payer |
$1,497.54
|
|
|
WIRE 1.8MM PROV FIXATION LONG
|
Facility
|
IP
|
$1,760.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.85 |
| Max. Negotiated Rate |
$1,689.96 |
| Rate for Payer: Aetna Commercial |
$1,355.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.10
|
| Rate for Payer: Cash Price |
$880.19
|
| Rate for Payer: Cigna Commercial |
$1,461.12
|
| Rate for Payer: First Health Commercial |
$1,672.36
|
| Rate for Payer: Humana Commercial |
$1,496.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.72
|
| Rate for Payer: PHCS Commercial |
$1,689.96
|
| Rate for Payer: United Healthcare All Payer |
$1,549.13
|
|
|
WIRE 1.8MM PROV FIXATION LONG
|
Facility
|
OP
|
$1,760.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.85 |
| Max. Negotiated Rate |
$1,689.96 |
| Rate for Payer: Aetna Commercial |
$1,355.49
|
| Rate for Payer: Anthem Medicaid |
$605.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.10
|
| Rate for Payer: Cash Price |
$880.19
|
| Rate for Payer: Cigna Commercial |
$1,461.12
|
| Rate for Payer: First Health Commercial |
$1,672.36
|
| Rate for Payer: Humana Commercial |
$1,496.32
|
| Rate for Payer: Humana KY Medicaid |
$605.39
|
| Rate for Payer: Kentucky WC Medicaid |
$611.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.72
|
| Rate for Payer: PHCS Commercial |
$1,689.96
|
| Rate for Payer: United Healthcare All Payer |
$1,549.13
|
|
|
WIRE 1.8MM PROV FIXATION SHORT
|
Facility
|
OP
|
$1,736.92
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.80 |
| Max. Negotiated Rate |
$1,667.44 |
| Rate for Payer: Aetna Commercial |
$1,337.43
|
| Rate for Payer: Anthem Medicaid |
$597.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.80
|
| Rate for Payer: Cash Price |
$868.46
|
| Rate for Payer: Cigna Commercial |
$1,441.64
|
| Rate for Payer: First Health Commercial |
$1,650.07
|
| Rate for Payer: Humana Commercial |
$1,476.38
|
| Rate for Payer: Humana KY Medicaid |
$597.33
|
| Rate for Payer: Kentucky WC Medicaid |
$603.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.45
|
| Rate for Payer: PHCS Commercial |
$1,667.44
|
| Rate for Payer: United Healthcare All Payer |
$1,528.49
|
|
|
WIRE 1.8MM PROV FIXATION SHORT
|
Facility
|
IP
|
$1,736.92
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.80 |
| Max. Negotiated Rate |
$1,667.44 |
| Rate for Payer: Aetna Commercial |
$1,337.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.80
|
| Rate for Payer: Cash Price |
$868.46
|
| Rate for Payer: Cigna Commercial |
$1,441.64
|
| Rate for Payer: First Health Commercial |
$1,650.07
|
| Rate for Payer: Humana Commercial |
$1,476.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.45
|
| Rate for Payer: PHCS Commercial |
$1,667.44
|
| Rate for Payer: United Healthcare All Payer |
$1,528.49
|
|
|
WIRE 1.8MM TI BYT
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
WIRE 1.8MM TI BYT
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
WIRE 1.8MM TI OLIVE
|
Facility
|
OP
|
$3,401.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.16 |
| Max. Negotiated Rate |
$3,265.15 |
| Rate for Payer: Aetna Commercial |
$2,618.92
|
| Rate for Payer: Anthem Medicaid |
$1,169.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.94
|
| Rate for Payer: Cash Price |
$1,700.60
|
| Rate for Payer: Cigna Commercial |
$2,823.00
|
| Rate for Payer: First Health Commercial |
$3,231.14
|
| Rate for Payer: Humana Commercial |
$2,891.02
|
| Rate for Payer: Humana KY Medicaid |
$1,169.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,510.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,193.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,993.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.37
|
| Rate for Payer: PHCS Commercial |
$3,265.15
|
| Rate for Payer: United Healthcare All Payer |
$2,993.06
|
|
|
WIRE 1.8MM TI OLIVE
|
Facility
|
IP
|
$3,401.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.16 |
| Max. Negotiated Rate |
$3,265.15 |
| Rate for Payer: Aetna Commercial |
$2,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.94
|
| Rate for Payer: Cash Price |
$1,700.60
|
| Rate for Payer: Cigna Commercial |
$2,823.00
|
| Rate for Payer: First Health Commercial |
$3,231.14
|
| Rate for Payer: Humana Commercial |
$2,891.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,510.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,993.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.37
|
| Rate for Payer: PHCS Commercial |
$3,265.15
|
| Rate for Payer: United Healthcare All Payer |
$2,993.06
|
|
|
WIRE BAY PT CORTICAL 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
WIRE BAY PT CORTICAL 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
WIRE BAY PT CORTICAL 370MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
WIRE BAY PT CORTICAL 370MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
WIRE CC TROC 040*18
|
Facility
|
OP
|
$551.88
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.74 |
| Max. Negotiated Rate |
$529.80 |
| Rate for Payer: Aetna Commercial |
$424.95
|
| Rate for Payer: Anthem Medicaid |
$189.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$430.47
|
| Rate for Payer: Cash Price |
$275.94
|
| Rate for Payer: Cigna Commercial |
$458.06
|
| Rate for Payer: First Health Commercial |
$524.29
|
| Rate for Payer: Humana Commercial |
$469.10
|
| Rate for Payer: Humana KY Medicaid |
$189.79
|
| Rate for Payer: Kentucky WC Medicaid |
$191.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$452.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$407.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$485.65
|
| Rate for Payer: Ohio Health Group HMO |
$413.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.08
|
| Rate for Payer: PHCS Commercial |
$529.80
|
| Rate for Payer: United Healthcare All Payer |
$485.65
|
|
|
WIRE CC TROC 040*18
|
Facility
|
IP
|
$551.88
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.74 |
| Max. Negotiated Rate |
$529.80 |
| Rate for Payer: Aetna Commercial |
$424.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$430.47
|
| Rate for Payer: Cash Price |
$275.94
|
| Rate for Payer: Cigna Commercial |
$458.06
|
| Rate for Payer: First Health Commercial |
$524.29
|
| Rate for Payer: Humana Commercial |
$469.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$452.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$407.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$485.65
|
| Rate for Payer: Ohio Health Group HMO |
$413.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.08
|
| Rate for Payer: PHCS Commercial |
$529.80
|
| Rate for Payer: United Healthcare All Payer |
$485.65
|
|
|
WIRE CC TROC 040*24
|
Facility
|
OP
|
$557.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.46 |
| Max. Negotiated Rate |
$535.10 |
| Rate for Payer: Aetna Commercial |
$429.20
|
| Rate for Payer: Anthem Medicaid |
$191.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$434.77
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cigna Commercial |
$462.64
|
| Rate for Payer: First Health Commercial |
$529.53
|
| Rate for Payer: Humana Commercial |
$473.79
|
| Rate for Payer: Humana KY Medicaid |
$191.69
|
| Rate for Payer: Kentucky WC Medicaid |
$193.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$490.51
|
| Rate for Payer: Ohio Health Group HMO |
$418.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.79
|
| Rate for Payer: PHCS Commercial |
$535.10
|
| Rate for Payer: United Healthcare All Payer |
$490.51
|
|
|
WIRE CC TROC 040*24
|
Facility
|
IP
|
$557.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.46 |
| Max. Negotiated Rate |
$535.10 |
| Rate for Payer: Aetna Commercial |
$429.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$434.77
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cigna Commercial |
$462.64
|
| Rate for Payer: First Health Commercial |
$529.53
|
| Rate for Payer: Humana Commercial |
$473.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$490.51
|
| Rate for Payer: Ohio Health Group HMO |
$418.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.79
|
| Rate for Payer: PHCS Commercial |
$535.10
|
| Rate for Payer: United Healthcare All Payer |
$490.51
|
|
|
WIRE DIAMOND POINT 1.8X450MM
|
Facility
|
IP
|
$1,558.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.63 |
| Max. Negotiated Rate |
$1,496.35 |
| Rate for Payer: Aetna Commercial |
$1,200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.79
|
| Rate for Payer: Cash Price |
$779.35
|
| Rate for Payer: Cigna Commercial |
$1,293.72
|
| Rate for Payer: First Health Commercial |
$1,480.76
|
| Rate for Payer: Humana Commercial |
$1,324.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,278.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,169.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.20
|
| Rate for Payer: PHCS Commercial |
$1,496.35
|
| Rate for Payer: United Healthcare All Payer |
$1,371.66
|
|
