|
WIRE DIL BALLOON FIXED SZ6/7/8
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
WIRE GUIDE .035*480
|
Facility
|
IP
|
$1,792.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.74 |
| Max. Negotiated Rate |
$1,720.78 |
| Rate for Payer: Aetna Commercial |
$1,380.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.13
|
| Rate for Payer: Cash Price |
$896.24
|
| Rate for Payer: Cigna Commercial |
$1,487.76
|
| Rate for Payer: First Health Commercial |
$1,702.86
|
| Rate for Payer: Humana Commercial |
$1,523.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,469.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,322.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,577.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,344.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,433.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,559.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.81
|
| Rate for Payer: PHCS Commercial |
$1,720.78
|
| Rate for Payer: United Healthcare All Payer |
$1,577.38
|
|
|
WIRE GUIDE .035*480
|
Facility
|
OP
|
$1,792.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.74 |
| Max. Negotiated Rate |
$1,720.78 |
| Rate for Payer: Aetna Commercial |
$1,380.21
|
| Rate for Payer: Anthem Medicaid |
$616.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.13
|
| Rate for Payer: Cash Price |
$896.24
|
| Rate for Payer: Cigna Commercial |
$1,487.76
|
| Rate for Payer: First Health Commercial |
$1,702.86
|
| Rate for Payer: Humana Commercial |
$1,523.61
|
| Rate for Payer: Humana KY Medicaid |
$616.43
|
| Rate for Payer: Kentucky WC Medicaid |
$622.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,469.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,322.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,577.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,344.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,433.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,559.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.81
|
| Rate for Payer: PHCS Commercial |
$1,720.78
|
| Rate for Payer: United Healthcare All Payer |
$1,577.38
|
|
|
WIRE GUIDE 1.6MM
|
Facility
|
IP
|
$7,064.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,119.39 |
| Max. Negotiated Rate |
$6,782.05 |
| Rate for Payer: Aetna Commercial |
$5,439.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,510.42
|
| Rate for Payer: Cash Price |
$3,532.32
|
| Rate for Payer: Cigna Commercial |
$5,863.65
|
| Rate for Payer: First Health Commercial |
$6,711.41
|
| Rate for Payer: Humana Commercial |
$6,004.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,793.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,213.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,119.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,216.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,298.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,651.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,146.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,874.60
|
| Rate for Payer: PHCS Commercial |
$6,782.05
|
| Rate for Payer: United Healthcare All Payer |
$6,216.88
|
|
|
WIRE GUIDE 1.6MM
|
Facility
|
OP
|
$7,064.64
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,119.39 |
| Max. Negotiated Rate |
$6,782.05 |
| Rate for Payer: Aetna Commercial |
$5,439.77
|
| Rate for Payer: Anthem Medicaid |
$2,429.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,510.42
|
| Rate for Payer: Cash Price |
$3,532.32
|
| Rate for Payer: Cigna Commercial |
$5,863.65
|
| Rate for Payer: First Health Commercial |
$6,711.41
|
| Rate for Payer: Humana Commercial |
$6,004.94
|
| Rate for Payer: Humana KY Medicaid |
$2,429.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,454.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,793.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,213.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,119.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,478.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,216.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,298.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,651.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,146.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,874.60
|
| Rate for Payer: PHCS Commercial |
$6,782.05
|
| Rate for Payer: United Healthcare All Payer |
$6,216.88
|
|
|
WIREGUIDE ACUTRAK PARLLEL .045
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
WIREGUIDE ACUTRAK PARLLEL .045
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
WIREGUIDE ACUTRAK PARLLEL .054
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
WIREGUIDE ACUTRAK PARLLEL .054
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
WIRE GUIDE DUOFLEX AW-01700
|
Facility
|
IP
|
$454.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$436.20 |
| Rate for Payer: Aetna Commercial |
$349.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.41
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cigna Commercial |
$377.13
|
| Rate for Payer: First Health Commercial |
$431.65
|
| Rate for Payer: Humana Commercial |
$386.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.85
|
| Rate for Payer: Ohio Health Group HMO |
$340.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.52
|
| Rate for Payer: PHCS Commercial |
$436.20
|
| Rate for Payer: United Healthcare All Payer |
$399.85
|
|
|
WIRE GUIDE DUOFLEX AW-01700
|
Facility
|
OP
|
$454.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.31 |
| Max. Negotiated Rate |
$436.20 |
| Rate for Payer: Aetna Commercial |
$349.86
|
| Rate for Payer: Anthem Medicaid |
$156.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.41
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cigna Commercial |
$377.13
|
| Rate for Payer: First Health Commercial |
$431.65
|
| Rate for Payer: Humana Commercial |
$386.21
|
| Rate for Payer: Humana KY Medicaid |
$156.26
|
| Rate for Payer: Kentucky WC Medicaid |
$157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$372.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$399.85
|
| Rate for Payer: Ohio Health Group HMO |
$340.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.52
|
| Rate for Payer: PHCS Commercial |
$436.20
|
| Rate for Payer: United Healthcare All Payer |
$399.85
|
|
|
WIRE GUIDE DUOFLEX SPRING .018
|
Facility
|
IP
|
$170.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$163.56 |
| Rate for Payer: Aetna Commercial |
$131.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.89
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cigna Commercial |
$141.41
|
| Rate for Payer: First Health Commercial |
$161.85
|
| Rate for Payer: Humana Commercial |
$144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.93
|
| Rate for Payer: Ohio Health Group HMO |
$127.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.56
|
| Rate for Payer: PHCS Commercial |
$163.56
|
| Rate for Payer: United Healthcare All Payer |
$149.93
|
|
|
WIRE GUIDE DUOFLEX SPRING .018
|
Facility
|
OP
|
$170.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$163.56 |
| Rate for Payer: Aetna Commercial |
$131.18
|
| Rate for Payer: Anthem Medicaid |
$58.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.89
|
| Rate for Payer: Cash Price |
$85.18
|
| Rate for Payer: Cigna Commercial |
$141.41
|
| Rate for Payer: First Health Commercial |
$161.85
|
| Rate for Payer: Humana Commercial |
$144.81
|
| Rate for Payer: Humana KY Medicaid |
$58.59
|
| Rate for Payer: Kentucky WC Medicaid |
$59.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.93
|
| Rate for Payer: Ohio Health Group HMO |
$127.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.56
|
| Rate for Payer: PHCS Commercial |
$163.56
|
| Rate for Payer: United Healthcare All Payer |
$149.93
|
|
|
WIREGUIDE SPRING DUOFLEX
|
Facility
|
OP
|
$173.88
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$166.92 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.63
|
| Rate for Payer: Cash Price |
$86.94
|
| Rate for Payer: Cigna Commercial |
$144.32
|
| Rate for Payer: First Health Commercial |
$165.19
|
| Rate for Payer: Humana Commercial |
$147.80
|
| Rate for Payer: Humana KY Medicaid |
$59.80
|
| Rate for Payer: Kentucky WC Medicaid |
$60.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.01
|
| Rate for Payer: Ohio Health Group HMO |
$130.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.98
|
| Rate for Payer: PHCS Commercial |
$166.92
|
| Rate for Payer: United Healthcare All Payer |
$153.01
|
|
|
WIREGUIDE SPRING DUOFLEX
|
Facility
|
IP
|
$173.88
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$166.92 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.63
|
| Rate for Payer: Cash Price |
$86.94
|
| Rate for Payer: Cigna Commercial |
$144.32
|
| Rate for Payer: First Health Commercial |
$165.19
|
| Rate for Payer: Humana Commercial |
$147.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.01
|
| Rate for Payer: Ohio Health Group HMO |
$130.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.98
|
| Rate for Payer: PHCS Commercial |
$166.92
|
| Rate for Payer: United Healthcare All Payer |
$153.01
|
|
|
WIRE GUIDE THRD 1.6 F/SYNTHES
|
Facility
|
OP
|
$773.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.16 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Aetna Commercial |
$595.86
|
| Rate for Payer: Anthem Medicaid |
$266.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.60
|
| Rate for Payer: Cash Price |
$386.92
|
| Rate for Payer: Cigna Commercial |
$642.30
|
| Rate for Payer: First Health Commercial |
$735.16
|
| Rate for Payer: Humana Commercial |
$657.77
|
| Rate for Payer: Humana KY Medicaid |
$266.13
|
| Rate for Payer: Kentucky WC Medicaid |
$268.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$680.99
|
| Rate for Payer: Ohio Health Group HMO |
$580.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.96
|
| Rate for Payer: PHCS Commercial |
$742.90
|
| Rate for Payer: United Healthcare All Payer |
$680.99
|
|
|
WIRE GUIDE THRD 1.6 F/SYNTHES
|
Facility
|
IP
|
$773.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.16 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Aetna Commercial |
$595.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.60
|
| Rate for Payer: Cash Price |
$386.92
|
| Rate for Payer: Cigna Commercial |
$642.30
|
| Rate for Payer: First Health Commercial |
$735.16
|
| Rate for Payer: Humana Commercial |
$657.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$680.99
|
| Rate for Payer: Ohio Health Group HMO |
$580.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.96
|
| Rate for Payer: PHCS Commercial |
$742.90
|
| Rate for Payer: United Healthcare All Payer |
$680.99
|
|
|
WIRE GUIDE TI .035*6
|
Facility
|
IP
|
$439.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
WIRE GUIDE TI .035*6
|
Facility
|
OP
|
$439.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem Medicaid |
$151.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Humana KY Medicaid |
$151.06
|
| Rate for Payer: Kentucky WC Medicaid |
$152.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
WIRE GUIDE TI .062*6
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
WIRE GUIDE TI .062*6
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
WIRE PLATE SMALL
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
WIRE PLATE SMALL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
WIRE SHORT BOLT
|
Facility
|
OP
|
$1,573.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.19 |
| Max. Negotiated Rate |
$1,511.00 |
| Rate for Payer: Aetna Commercial |
$1,211.95
|
| Rate for Payer: Anthem Medicaid |
$541.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,227.69
|
| Rate for Payer: Cash Price |
$786.98
|
| Rate for Payer: Cigna Commercial |
$1,306.39
|
| Rate for Payer: First Health Commercial |
$1,495.26
|
| Rate for Payer: Humana Commercial |
$1,337.87
|
| Rate for Payer: Humana KY Medicaid |
$541.28
|
| Rate for Payer: Kentucky WC Medicaid |
$546.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,290.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,161.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,385.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,180.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,259.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,369.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.03
|
| Rate for Payer: PHCS Commercial |
$1,511.00
|
| Rate for Payer: United Healthcare All Payer |
$1,385.08
|
|
|
WIRE SHORT BOLT
|
Facility
|
IP
|
$1,573.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.19 |
| Max. Negotiated Rate |
$1,511.00 |
| Rate for Payer: Aetna Commercial |
$1,211.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,227.69
|
| Rate for Payer: Cash Price |
$786.98
|
| Rate for Payer: Cigna Commercial |
$1,306.39
|
| Rate for Payer: First Health Commercial |
$1,495.26
|
| Rate for Payer: Humana Commercial |
$1,337.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,290.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,161.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,385.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,180.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,259.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,369.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.03
|
| Rate for Payer: PHCS Commercial |
$1,511.00
|
| Rate for Payer: United Healthcare All Payer |
$1,385.08
|
|
