|
WIRE DIAMOND POINT 1.8X450MM
|
Facility
|
OP
|
$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 Medicaid |
$536.04
|
| 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: Humana KY Medicaid |
$536.04
|
| Rate for Payer: Kentucky WC Medicaid |
$541.49
|
| 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: Molina Healthcare Medicaid |
$546.79
|
| 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
|
|
|
WIRE DIL BALLOON FIXED SZ6/7/8
|
Facility
|
OP
|
$1,815.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,742.88 |
| Rate for Payer: Aetna Commercial |
$1,397.94
|
| Rate for Payer: Anthem Medicaid |
$624.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.09
|
| Rate for Payer: Cash Price |
$907.75
|
| Rate for Payer: Cigna Commercial |
$1,506.86
|
| Rate for Payer: First Health Commercial |
$1,724.72
|
| Rate for Payer: Humana Commercial |
$1,543.18
|
| Rate for Payer: Humana KY Medicaid |
$624.35
|
| Rate for Payer: Kentucky WC Medicaid |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.80
|
| Rate for Payer: PHCS Commercial |
$1,742.88
|
| Rate for Payer: United Healthcare All Payer |
$1,597.64
|
|
|
WIRE DIL BALLOON FIXED SZ6/7/8
|
Facility
|
IP
|
$1,815.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,742.88 |
| Rate for Payer: Aetna Commercial |
$1,397.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.09
|
| Rate for Payer: Cash Price |
$907.75
|
| Rate for Payer: Cigna Commercial |
$1,506.86
|
| Rate for Payer: First Health Commercial |
$1,724.72
|
| Rate for Payer: Humana Commercial |
$1,543.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.80
|
| Rate for Payer: PHCS Commercial |
$1,742.88
|
| Rate for Payer: United Healthcare All Payer |
$1,597.64
|
|
|
WIRE GUIDE .035*480
|
Facility
|
OP
|
$1,803.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.47 |
| Max. Negotiated Rate |
$1,731.46 |
| Rate for Payer: Aetna Commercial |
$1,388.77
|
| Rate for Payer: Anthem Medicaid |
$620.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,406.81
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna Commercial |
$1,496.99
|
| Rate for Payer: First Health Commercial |
$1,713.42
|
| Rate for Payer: Humana Commercial |
$1,533.06
|
| Rate for Payer: Humana KY Medicaid |
$620.26
|
| Rate for Payer: Kentucky WC Medicaid |
$626.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,331.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,587.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,352.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.12
|
| Rate for Payer: PHCS Commercial |
$1,731.46
|
| Rate for Payer: United Healthcare All Payer |
$1,587.17
|
|
|
WIRE GUIDE .035*480
|
Facility
|
IP
|
$1,803.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.47 |
| Max. Negotiated Rate |
$1,731.46 |
| Rate for Payer: Aetna Commercial |
$1,388.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,406.81
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna Commercial |
$1,496.99
|
| Rate for Payer: First Health Commercial |
$1,713.42
|
| Rate for Payer: Humana Commercial |
$1,533.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,331.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,587.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,352.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.12
|
| Rate for Payer: PHCS Commercial |
$1,731.46
|
| Rate for Payer: United Healthcare All Payer |
$1,587.17
|
|
|
WIRE GUIDE 1.6MM
|
Facility
|
OP
|
$6,864.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.40 |
| Max. Negotiated Rate |
$6,590.05 |
| Rate for Payer: Aetna Commercial |
$5,285.77
|
| Rate for Payer: Anthem Medicaid |
$2,360.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,354.42
|
| Rate for Payer: Cash Price |
$3,432.32
|
| Rate for Payer: Cigna Commercial |
$5,697.65
|
| Rate for Payer: First Health Commercial |
$6,521.41
|
| Rate for Payer: Humana Commercial |
$5,834.94
|
| Rate for Payer: Humana KY Medicaid |
$2,360.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,384.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,629.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,066.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,059.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,408.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,040.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,148.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.04
|
| Rate for Payer: PHCS Commercial |
$6,590.05
|
| Rate for Payer: United Healthcare All Payer |
$6,040.88
|
|
|
WIRE GUIDE 1.6MM
|
Facility
|
IP
|
$6,864.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.40 |
| Max. Negotiated Rate |
$6,590.05 |
| Rate for Payer: Aetna Commercial |
$5,285.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,354.42
|
| Rate for Payer: Cash Price |
$3,432.32
|
| Rate for Payer: Cigna Commercial |
$5,697.65
|
| Rate for Payer: First Health Commercial |
$6,521.41
|
| Rate for Payer: Humana Commercial |
$5,834.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,629.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,066.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,059.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,040.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,148.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,372.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.04
|
| Rate for Payer: PHCS Commercial |
$6,590.05
|
| Rate for Payer: United Healthcare All Payer |
$6,040.88
|
|
|
WIREGUIDE ACUTRAK PARLLEL .045
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem Medicaid |
$656.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Humana KY Medicaid |
$656.85
|
| Rate for Payer: Kentucky WC Medicaid |
$663.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
WIREGUIDE ACUTRAK PARLLEL .045
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
WIREGUIDE ACUTRAK PARLLEL .054
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem Medicaid |
$656.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Humana KY Medicaid |
$656.85
|
| Rate for Payer: Kentucky WC Medicaid |
$663.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
WIREGUIDE ACUTRAK PARLLEL .054
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
WIRE GUIDE DUOFLEX AW-01700
|
Facility
|
OP
|
$451.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$433.02 |
| Rate for Payer: Aetna Commercial |
$347.32
|
| Rate for Payer: Anthem Medicaid |
$155.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.83
|
| Rate for Payer: Cash Price |
$225.53
|
| Rate for Payer: Cigna Commercial |
$374.38
|
| Rate for Payer: First Health Commercial |
$428.51
|
| Rate for Payer: Humana Commercial |
$383.40
|
| Rate for Payer: Humana KY Medicaid |
$155.12
|
| Rate for Payer: Kentucky WC Medicaid |
$156.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.93
|
| Rate for Payer: Ohio Health Group HMO |
$338.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.83
|
| Rate for Payer: PHCS Commercial |
$433.02
|
| Rate for Payer: United Healthcare All Payer |
$396.93
|
|
|
WIRE GUIDE DUOFLEX AW-01700
|
Facility
|
IP
|
$451.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$433.02 |
| Rate for Payer: Aetna Commercial |
$347.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.83
|
| Rate for Payer: Cash Price |
$225.53
|
| Rate for Payer: Cigna Commercial |
$374.38
|
| Rate for Payer: First Health Commercial |
$428.51
|
| Rate for Payer: Humana Commercial |
$383.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.93
|
| Rate for Payer: Ohio Health Group HMO |
$338.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.83
|
| Rate for Payer: PHCS Commercial |
$433.02
|
| Rate for Payer: United Healthcare All Payer |
$396.93
|
|
|
WIRE GUIDE DUOFLEX SPRING .018
|
Facility
|
IP
|
$166.21
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: Aetna Commercial |
$127.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.64
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Cigna Commercial |
$137.95
|
| Rate for Payer: First Health Commercial |
$157.90
|
| Rate for Payer: Humana Commercial |
$141.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.26
|
| Rate for Payer: Ohio Health Group HMO |
$124.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.53
|
| Rate for Payer: PHCS Commercial |
$159.56
|
| Rate for Payer: United Healthcare All Payer |
$146.26
|
|
|
WIRE GUIDE DUOFLEX SPRING .018
|
Facility
|
OP
|
$166.21
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: Aetna Commercial |
$127.98
|
| Rate for Payer: Anthem Medicaid |
$57.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.64
|
| Rate for Payer: Cash Price |
$83.11
|
| Rate for Payer: Cigna Commercial |
$137.95
|
| Rate for Payer: First Health Commercial |
$157.90
|
| Rate for Payer: Humana Commercial |
$141.28
|
| Rate for Payer: Humana KY Medicaid |
$57.16
|
| Rate for Payer: Kentucky WC Medicaid |
$57.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.26
|
| Rate for Payer: Ohio Health Group HMO |
$124.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.53
|
| Rate for Payer: PHCS Commercial |
$159.56
|
| Rate for Payer: United Healthcare All Payer |
$146.26
|
|
|
WIREGUIDE SPRING DUOFLEX
|
Facility
|
OP
|
$435.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$418.29 |
| Rate for Payer: Aetna Commercial |
$335.50
|
| Rate for Payer: Anthem Medicaid |
$149.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.86
|
| Rate for Payer: Cash Price |
$217.86
|
| Rate for Payer: Cigna Commercial |
$361.65
|
| Rate for Payer: First Health Commercial |
$413.93
|
| Rate for Payer: Humana Commercial |
$370.36
|
| Rate for Payer: Humana KY Medicaid |
$149.84
|
| Rate for Payer: Kentucky WC Medicaid |
$151.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$152.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$383.43
|
| Rate for Payer: Ohio Health Group HMO |
$326.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.07
|
| Rate for Payer: PHCS Commercial |
$418.29
|
| Rate for Payer: United Healthcare All Payer |
$383.43
|
|
|
WIREGUIDE SPRING DUOFLEX
|
Facility
|
IP
|
$435.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$418.29 |
| Rate for Payer: Aetna Commercial |
$335.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.86
|
| Rate for Payer: Cash Price |
$217.86
|
| Rate for Payer: Cigna Commercial |
$361.65
|
| Rate for Payer: First Health Commercial |
$413.93
|
| Rate for Payer: Humana Commercial |
$370.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$383.43
|
| Rate for Payer: Ohio Health Group HMO |
$326.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.07
|
| Rate for Payer: PHCS Commercial |
$418.29
|
| Rate for Payer: United Healthcare All Payer |
$383.43
|
|
|
WIRE GUIDE THRD 1.6 F/SYNTHES
|
Facility
|
IP
|
$756.46
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.34 |
| Max. Negotiated Rate |
$726.20 |
| Rate for Payer: Aetna Commercial |
$582.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.04
|
| Rate for Payer: Cash Price |
$378.23
|
| Rate for Payer: Cigna Commercial |
$627.86
|
| Rate for Payer: First Health Commercial |
$718.64
|
| Rate for Payer: Humana Commercial |
$642.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$620.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$558.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$665.68
|
| Rate for Payer: Ohio Health Group HMO |
$567.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.50
|
| Rate for Payer: PHCS Commercial |
$726.20
|
| Rate for Payer: United Healthcare All Payer |
$665.68
|
|
|
WIRE GUIDE THRD 1.6 F/SYNTHES
|
Facility
|
OP
|
$756.46
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.34 |
| Max. Negotiated Rate |
$726.20 |
| Rate for Payer: Aetna Commercial |
$582.47
|
| Rate for Payer: Anthem Medicaid |
$260.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.04
|
| Rate for Payer: Cash Price |
$378.23
|
| Rate for Payer: Cigna Commercial |
$627.86
|
| Rate for Payer: First Health Commercial |
$718.64
|
| Rate for Payer: Humana Commercial |
$642.99
|
| Rate for Payer: Humana KY Medicaid |
$260.15
|
| Rate for Payer: Kentucky WC Medicaid |
$262.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$620.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$558.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$665.68
|
| Rate for Payer: Ohio Health Group HMO |
$567.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.50
|
| Rate for Payer: PHCS Commercial |
$726.20
|
| Rate for Payer: United Healthcare All Payer |
$665.68
|
|
|
WIRE GUIDE TI .035*6
|
Facility
|
OP
|
$436.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Humana KY Medicaid |
$150.11
|
| Rate for Payer: Kentucky WC Medicaid |
$151.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
WIRE GUIDE TI .035*6
|
Facility
|
IP
|
$436.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
WIRE GUIDE TI .062*6
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
WIRE GUIDE TI .062*6
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem Medicaid |
$262.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Humana KY Medicaid |
$262.05
|
| Rate for Payer: Kentucky WC Medicaid |
$264.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
WIRE SHORT BOLT
|
Facility
|
IP
|
$1,594.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.28 |
| Max. Negotiated Rate |
$1,530.65 |
| Rate for Payer: Aetna Commercial |
$1,227.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,243.66
|
| Rate for Payer: Cash Price |
$797.22
|
| Rate for Payer: Cigna Commercial |
$1,323.38
|
| Rate for Payer: First Health Commercial |
$1,514.71
|
| Rate for Payer: Humana Commercial |
$1,355.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,307.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,176.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,403.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,195.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.27
|
| Rate for Payer: PHCS Commercial |
$1,530.65
|
| Rate for Payer: United Healthcare All Payer |
$1,403.10
|
|
|
WIRE SHORT BOLT
|
Facility
|
OP
|
$1,594.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.28 |
| Max. Negotiated Rate |
$1,530.65 |
| Rate for Payer: Aetna Commercial |
$1,227.71
|
| Rate for Payer: Anthem Medicaid |
$548.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,243.66
|
| Rate for Payer: Cash Price |
$797.22
|
| Rate for Payer: Cigna Commercial |
$1,323.38
|
| Rate for Payer: First Health Commercial |
$1,514.71
|
| Rate for Payer: Humana Commercial |
$1,355.27
|
| Rate for Payer: Humana KY Medicaid |
$548.32
|
| Rate for Payer: Kentucky WC Medicaid |
$553.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,307.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,176.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$559.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,403.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,195.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.27
|
| Rate for Payer: PHCS Commercial |
$1,530.65
|
| Rate for Payer: United Healthcare All Payer |
$1,403.10
|
|
