|
WIRE 1.1MM PROV FIXATION 6MM
|
Facility
|
OP
|
$1,694.63
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$508.39 |
| Max. Negotiated Rate |
$1,626.84 |
| Rate for Payer: Aetna Commercial |
$1,304.87
|
| Rate for Payer: Anthem Medicaid |
$582.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.81
|
| Rate for Payer: Cash Price |
$847.32
|
| Rate for Payer: Cigna Commercial |
$1,406.54
|
| Rate for Payer: First Health Commercial |
$1,609.90
|
| Rate for Payer: Humana Commercial |
$1,440.44
|
| Rate for Payer: Humana KY Medicaid |
$582.78
|
| Rate for Payer: Kentucky WC Medicaid |
$588.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,355.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.29
|
| Rate for Payer: PHCS Commercial |
$1,626.84
|
| Rate for Payer: United Healthcare All Payer |
$1,491.27
|
|
|
WIRE 1.1MM PROV FIXATION 6MM
|
Facility
|
IP
|
$1,694.63
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$508.39 |
| Max. Negotiated Rate |
$1,626.84 |
| Rate for Payer: Aetna Commercial |
$1,304.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,321.81
|
| Rate for Payer: Cash Price |
$847.32
|
| Rate for Payer: Cigna Commercial |
$1,406.54
|
| Rate for Payer: First Health Commercial |
$1,609.90
|
| Rate for Payer: Humana Commercial |
$1,440.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,250.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,270.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,355.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.29
|
| Rate for Payer: PHCS Commercial |
$1,626.84
|
| Rate for Payer: United Healthcare All Payer |
$1,491.27
|
|
|
WIRE 1.5MM PROV FIXATION LONG
|
Facility
|
OP
|
$1,681.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.57 |
| Max. Negotiated Rate |
$1,614.62 |
| Rate for Payer: Aetna Commercial |
$1,295.06
|
| Rate for Payer: Anthem Medicaid |
$578.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.88
|
| Rate for Payer: Cash Price |
$840.95
|
| Rate for Payer: Cigna Commercial |
$1,395.98
|
| Rate for Payer: First Health Commercial |
$1,597.81
|
| Rate for Payer: Humana Commercial |
$1,429.62
|
| Rate for Payer: Humana KY Medicaid |
$578.41
|
| Rate for Payer: Kentucky WC Medicaid |
$584.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.51
|
| Rate for Payer: PHCS Commercial |
$1,614.62
|
| Rate for Payer: United Healthcare All Payer |
$1,480.07
|
|
|
WIRE 1.5MM PROV FIXATION LONG
|
Facility
|
IP
|
$1,681.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.57 |
| Max. Negotiated Rate |
$1,614.62 |
| Rate for Payer: Aetna Commercial |
$1,295.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.88
|
| Rate for Payer: Cash Price |
$840.95
|
| Rate for Payer: Cigna Commercial |
$1,395.98
|
| Rate for Payer: First Health Commercial |
$1,597.81
|
| Rate for Payer: Humana Commercial |
$1,429.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.51
|
| Rate for Payer: PHCS Commercial |
$1,614.62
|
| Rate for Payer: United Healthcare All Payer |
$1,480.07
|
|
|
WIRE 1.5MM PROV FIXATION SHORT
|
Facility
|
IP
|
$1,681.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.57 |
| Max. Negotiated Rate |
$1,614.62 |
| Rate for Payer: Aetna Commercial |
$1,295.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.88
|
| Rate for Payer: Cash Price |
$840.95
|
| Rate for Payer: Cigna Commercial |
$1,395.98
|
| Rate for Payer: First Health Commercial |
$1,597.81
|
| Rate for Payer: Humana Commercial |
$1,429.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.51
|
| Rate for Payer: PHCS Commercial |
$1,614.62
|
| Rate for Payer: United Healthcare All Payer |
$1,480.07
|
|
|
WIRE 1.5MM PROV FIXATION SHORT
|
Facility
|
OP
|
$1,681.90
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.57 |
| Max. Negotiated Rate |
$1,614.62 |
| Rate for Payer: Aetna Commercial |
$1,295.06
|
| Rate for Payer: Anthem Medicaid |
$578.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.88
|
| Rate for Payer: Cash Price |
$840.95
|
| Rate for Payer: Cigna Commercial |
$1,395.98
|
| Rate for Payer: First Health Commercial |
$1,597.81
|
| Rate for Payer: Humana Commercial |
$1,429.62
|
| Rate for Payer: Humana KY Medicaid |
$578.41
|
| Rate for Payer: Kentucky WC Medicaid |
$584.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.51
|
| Rate for Payer: PHCS Commercial |
$1,614.62
|
| Rate for Payer: United Healthcare All Payer |
$1,480.07
|
|
|
WIRE 1.8MM PROV FIXATION LONG
|
Facility
|
OP
|
$1,745.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$523.66 |
| Max. Negotiated Rate |
$1,675.73 |
| Rate for Payer: Aetna Commercial |
$1,344.07
|
| Rate for Payer: Anthem Medicaid |
$600.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.53
|
| Rate for Payer: Cash Price |
$872.78
|
| Rate for Payer: Cigna Commercial |
$1,448.81
|
| Rate for Payer: First Health Commercial |
$1,658.27
|
| Rate for Payer: Humana Commercial |
$1,483.72
|
| Rate for Payer: Humana KY Medicaid |
$600.29
|
| Rate for Payer: Kentucky WC Medicaid |
$606.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.43
|
| Rate for Payer: PHCS Commercial |
$1,675.73
|
| Rate for Payer: United Healthcare All Payer |
$1,536.08
|
|
|
WIRE 1.8MM PROV FIXATION LONG
|
Facility
|
IP
|
$1,745.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$523.66 |
| Max. Negotiated Rate |
$1,675.73 |
| Rate for Payer: Aetna Commercial |
$1,344.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.53
|
| Rate for Payer: Cash Price |
$872.78
|
| Rate for Payer: Cigna Commercial |
$1,448.81
|
| Rate for Payer: First Health Commercial |
$1,658.27
|
| Rate for Payer: Humana Commercial |
$1,483.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.43
|
| Rate for Payer: PHCS Commercial |
$1,675.73
|
| Rate for Payer: United Healthcare All Payer |
$1,536.08
|
|
|
WIRE 1.8MM PROV FIXATION SHORT
|
Facility
|
IP
|
$1,720.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.03 |
| Max. Negotiated Rate |
$1,651.29 |
| Rate for Payer: Aetna Commercial |
$1,324.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.67
|
| Rate for Payer: Cash Price |
$860.04
|
| Rate for Payer: Cigna Commercial |
$1,427.67
|
| Rate for Payer: First Health Commercial |
$1,634.09
|
| Rate for Payer: Humana Commercial |
$1,462.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.86
|
| Rate for Payer: PHCS Commercial |
$1,651.29
|
| Rate for Payer: United Healthcare All Payer |
$1,513.68
|
|
|
WIRE 1.8MM PROV FIXATION SHORT
|
Facility
|
OP
|
$1,720.09
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.03 |
| Max. Negotiated Rate |
$1,651.29 |
| Rate for Payer: Aetna Commercial |
$1,324.47
|
| Rate for Payer: Anthem Medicaid |
$591.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.67
|
| Rate for Payer: Cash Price |
$860.04
|
| Rate for Payer: Cigna Commercial |
$1,427.67
|
| Rate for Payer: First Health Commercial |
$1,634.09
|
| Rate for Payer: Humana Commercial |
$1,462.08
|
| Rate for Payer: Humana KY Medicaid |
$591.54
|
| Rate for Payer: Kentucky WC Medicaid |
$597.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.86
|
| Rate for Payer: PHCS Commercial |
$1,651.29
|
| Rate for Payer: United Healthcare All Payer |
$1,513.68
|
|
|
WIRE 1.8MM TI BYT
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
WIRE 1.8MM TI BYT
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
WIRE 1.8MM TI OLIVE
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$986.10 |
| Max. Negotiated Rate |
$3,155.52 |
| Rate for Payer: Aetna Commercial |
$2,530.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.86
|
| Rate for Payer: Cash Price |
$1,643.50
|
| Rate for Payer: Cigna Commercial |
$2,728.21
|
| Rate for Payer: First Health Commercial |
$3,122.65
|
| Rate for Payer: Humana Commercial |
$2,793.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,695.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,465.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,859.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,268.03
|
| Rate for Payer: PHCS Commercial |
$3,155.52
|
| Rate for Payer: United Healthcare All Payer |
$2,892.56
|
|
|
WIRE 1.8MM TI OLIVE
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$986.10 |
| Max. Negotiated Rate |
$3,155.52 |
| Rate for Payer: Aetna Commercial |
$2,530.99
|
| Rate for Payer: Anthem Medicaid |
$1,130.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.86
|
| Rate for Payer: Cash Price |
$1,643.50
|
| Rate for Payer: Cigna Commercial |
$2,728.21
|
| Rate for Payer: First Health Commercial |
$3,122.65
|
| Rate for Payer: Humana Commercial |
$2,793.95
|
| Rate for Payer: Humana KY Medicaid |
$1,130.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,141.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,695.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,153.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,465.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,629.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,859.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,268.03
|
| Rate for Payer: PHCS Commercial |
$3,155.52
|
| Rate for Payer: United Healthcare All Payer |
$2,892.56
|
|
|
WIRE BAY PT CORTICAL 300MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
WIRE BAY PT CORTICAL 300MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
WIRE CC TROC 040*18
|
Facility
|
IP
|
$559.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$536.70 |
| Rate for Payer: Aetna Commercial |
$430.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.07
|
| Rate for Payer: Cash Price |
$279.53
|
| Rate for Payer: Cigna Commercial |
$464.02
|
| Rate for Payer: First Health Commercial |
$531.11
|
| Rate for Payer: Humana Commercial |
$475.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.97
|
| Rate for Payer: Ohio Health Group HMO |
$419.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.75
|
| Rate for Payer: PHCS Commercial |
$536.70
|
| Rate for Payer: United Healthcare All Payer |
$491.97
|
|
|
WIRE CC TROC 040*18
|
Facility
|
OP
|
$559.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$536.70 |
| Rate for Payer: Aetna Commercial |
$430.48
|
| Rate for Payer: Anthem Medicaid |
$192.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.07
|
| Rate for Payer: Cash Price |
$279.53
|
| Rate for Payer: Cigna Commercial |
$464.02
|
| Rate for Payer: First Health Commercial |
$531.11
|
| Rate for Payer: Humana Commercial |
$475.20
|
| Rate for Payer: Humana KY Medicaid |
$192.26
|
| Rate for Payer: Kentucky WC Medicaid |
$194.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.97
|
| Rate for Payer: Ohio Health Group HMO |
$419.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.75
|
| Rate for Payer: PHCS Commercial |
$536.70
|
| Rate for Payer: United Healthcare All Payer |
$491.97
|
|
|
WIRE CC TROC 040*24
|
Facility
|
IP
|
$564.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$542.21 |
| Rate for Payer: Aetna Commercial |
$434.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.54
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cigna Commercial |
$468.78
|
| Rate for Payer: First Health Commercial |
$536.56
|
| Rate for Payer: Humana Commercial |
$480.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.02
|
| Rate for Payer: Ohio Health Group HMO |
$423.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$491.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.71
|
| Rate for Payer: PHCS Commercial |
$542.21
|
| Rate for Payer: United Healthcare All Payer |
$497.02
|
|
|
WIRE CC TROC 040*24
|
Facility
|
OP
|
$564.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$542.21 |
| Rate for Payer: Aetna Commercial |
$434.90
|
| Rate for Payer: Anthem Medicaid |
$194.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.54
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cigna Commercial |
$468.78
|
| Rate for Payer: First Health Commercial |
$536.56
|
| Rate for Payer: Humana Commercial |
$480.08
|
| Rate for Payer: Humana KY Medicaid |
$194.23
|
| Rate for Payer: Kentucky WC Medicaid |
$196.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.02
|
| Rate for Payer: Ohio Health Group HMO |
$423.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$491.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.71
|
| Rate for Payer: PHCS Commercial |
$542.21
|
| Rate for Payer: United Healthcare All Payer |
$497.02
|
|
|
WIRE DIAMOND POINT 1.8X450MM
|
Facility
|
IP
|
$1,535.16
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.55 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Aetna Commercial |
$1,182.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.42
|
| Rate for Payer: Cash Price |
$767.58
|
| Rate for Payer: Cigna Commercial |
$1,274.18
|
| Rate for Payer: First Health Commercial |
$1,458.40
|
| Rate for Payer: Humana Commercial |
$1,304.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,258.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,132.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,350.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,335.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.26
|
| Rate for Payer: PHCS Commercial |
$1,473.75
|
| Rate for Payer: United Healthcare All Payer |
$1,350.94
|
|
|
WIRE DIAMOND POINT 1.8X450MM
|
Facility
|
OP
|
$1,535.16
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.55 |
| Max. Negotiated Rate |
$1,473.75 |
| Rate for Payer: Aetna Commercial |
$1,182.07
|
| Rate for Payer: Anthem Medicaid |
$527.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.42
|
| Rate for Payer: Cash Price |
$767.58
|
| Rate for Payer: Cigna Commercial |
$1,274.18
|
| Rate for Payer: First Health Commercial |
$1,458.40
|
| Rate for Payer: Humana Commercial |
$1,304.89
|
| Rate for Payer: Humana KY Medicaid |
$527.94
|
| Rate for Payer: Kentucky WC Medicaid |
$533.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,258.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,132.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,350.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,335.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.26
|
| Rate for Payer: PHCS Commercial |
$1,473.75
|
| Rate for Payer: United Healthcare All Payer |
$1,350.94
|
|
|
WIRE DIL BALLOON FIXED SZ6/7/8
|
Facility
|
OP
|
$1,805.40
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$541.62 |
| Max. Negotiated Rate |
$1,733.18 |
| Rate for Payer: Aetna Commercial |
$1,390.16
|
| Rate for Payer: Anthem Medicaid |
$620.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.21
|
| Rate for Payer: Cash Price |
$902.70
|
| Rate for Payer: Cigna Commercial |
$1,498.48
|
| Rate for Payer: First Health Commercial |
$1,715.13
|
| Rate for Payer: Humana Commercial |
$1,534.59
|
| Rate for Payer: Humana KY Medicaid |
$620.88
|
| Rate for Payer: Kentucky WC Medicaid |
$627.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,570.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.73
|
| Rate for Payer: PHCS Commercial |
$1,733.18
|
| Rate for Payer: United Healthcare All Payer |
$1,588.75
|
|
