|
POLAR CATH 8*40*120 8F
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
POLAR CATH 8*40*120 8F
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
POLARUS 3 GUIDE WIRE 20 BLUNT
|
Facility
|
IP
|
$1,561.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$1,499.04 |
| Rate for Payer: Aetna Commercial |
$1,202.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.97
|
| Rate for Payer: Cash Price |
$780.75
|
| Rate for Payer: Cigna Commercial |
$1,296.04
|
| Rate for Payer: First Health Commercial |
$1,483.42
|
| Rate for Payer: Humana Commercial |
$1,327.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.06
|
| Rate for Payer: PHCS Commercial |
$1,499.04
|
| Rate for Payer: United Healthcare All Payer |
$1,374.12
|
|
|
POLARUS 3 GUIDE WIRE 20 BLUNT
|
Facility
|
OP
|
$1,561.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$1,499.04 |
| Rate for Payer: Aetna Commercial |
$1,202.36
|
| Rate for Payer: Anthem Medicaid |
$537.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.97
|
| Rate for Payer: Cash Price |
$780.75
|
| Rate for Payer: Cigna Commercial |
$1,296.04
|
| Rate for Payer: First Health Commercial |
$1,483.42
|
| Rate for Payer: Humana Commercial |
$1,327.28
|
| Rate for Payer: Humana KY Medicaid |
$537.00
|
| Rate for Payer: Kentucky WC Medicaid |
$542.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.06
|
| Rate for Payer: PHCS Commercial |
$1,499.04
|
| Rate for Payer: United Healthcare All Payer |
$1,374.12
|
|
|
POLARUS PLUS ROD 8MM*200MM
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*200MM
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*220MM
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*220MM
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*240MM
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*240MM
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*260MM
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*260MM
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*280MM
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLARUS PLUS ROD 8MM*280MM
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
POLIBAR
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
25003891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.08
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.88
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Humana Commercial |
$30.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.68
|
| Rate for Payer: Ohio Health Group HMO |
$27.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.16
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
POLIBAR
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
25003891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.08
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.88
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Humana Commercial |
$30.60
|
| Rate for Payer: Humana KY Medicaid |
$12.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.68
|
| Rate for Payer: Ohio Health Group HMO |
$27.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.16
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
POLIO 1 TITER
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30001095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
POLIO 1 TITER
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30001095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem Medicaid |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.91
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Humana KY Medicaid |
$16.91
|
| Rate for Payer: Humana Medicare Advantage |
$16.91
|
| Rate for Payer: Kentucky WC Medicaid |
$17.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
POLIO 2 TITER
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30001094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$332.16 |
| Rate for Payer: Aetna Commercial |
$266.42
|
| Rate for Payer: Anthem Medicaid |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.91
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$287.18
|
| Rate for Payer: First Health Commercial |
$328.70
|
| Rate for Payer: Humana Commercial |
$294.10
|
| Rate for Payer: Humana KY Medicaid |
$16.91
|
| Rate for Payer: Humana Medicare Advantage |
$16.91
|
| Rate for Payer: Kentucky WC Medicaid |
$17.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.48
|
| Rate for Payer: Ohio Health Group HMO |
$259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.26
|
| Rate for Payer: PHCS Commercial |
$332.16
|
| Rate for Payer: United Healthcare All Payer |
$304.48
|
|
|
POLIO 2 TITER
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30001094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$332.16 |
| Rate for Payer: Aetna Commercial |
$266.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.84
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$287.18
|
| Rate for Payer: First Health Commercial |
$328.70
|
| Rate for Payer: Humana Commercial |
$294.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.48
|
| Rate for Payer: Ohio Health Group HMO |
$259.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.26
|
| Rate for Payer: PHCS Commercial |
$332.16
|
| Rate for Payer: United Healthcare All Payer |
$304.48
|
|
|
POLIO 3 TITER
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30001093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
POLIO 3 TITER
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30001093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem Medicaid |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.91
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Humana KY Medicaid |
$16.91
|
| Rate for Payer: Humana Medicare Advantage |
$16.91
|
| Rate for Payer: Kentucky WC Medicaid |
$17.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.98
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
POLIOVIRUS VACC INACTIVE (IPV)
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
77000041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Healthspan PPO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.72
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
POLIOVIRUS VACC INACTIVE (IPV)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
77000041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
POLIOVIRUS VACC INACTIVE (IPV)
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
770T0041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.58
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
