|
POLAR CATH 6*100*135 6F
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 6*100*165 6F
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 6*100*165 6F
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 6*150*135 7F
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
POLAR CATH 6*150*135 7F
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
POLAR CATH 6*4*135 6F
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 6*4*135 6F
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 7*40*120 7F
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 7*40*120 7F
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 8*40*120 8F
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLAR CATH 8*40*120 8F
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
POLARUS 3 GUIDE WIRE 20 BLUNT
|
Facility
|
OP
|
$1,538.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.46 |
| Max. Negotiated Rate |
$1,476.67 |
| Rate for Payer: Aetna Commercial |
$1,184.41
|
| Rate for Payer: Anthem Medicaid |
$528.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,199.80
|
| Rate for Payer: Cash Price |
$769.10
|
| Rate for Payer: Cigna Commercial |
$1,276.71
|
| Rate for Payer: First Health Commercial |
$1,461.29
|
| Rate for Payer: Humana Commercial |
$1,307.47
|
| Rate for Payer: Humana KY Medicaid |
$528.99
|
| Rate for Payer: Kentucky WC Medicaid |
$534.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,230.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,338.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.36
|
| Rate for Payer: PHCS Commercial |
$1,476.67
|
| Rate for Payer: United Healthcare All Payer |
$1,353.62
|
|
|
POLARUS 3 GUIDE WIRE 20 BLUNT
|
Facility
|
IP
|
$1,538.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.46 |
| Max. Negotiated Rate |
$1,476.67 |
| Rate for Payer: Aetna Commercial |
$1,184.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,199.80
|
| Rate for Payer: Cash Price |
$769.10
|
| Rate for Payer: Cigna Commercial |
$1,276.71
|
| Rate for Payer: First Health Commercial |
$1,461.29
|
| Rate for Payer: Humana Commercial |
$1,307.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,230.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,338.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.36
|
| Rate for Payer: PHCS Commercial |
$1,476.67
|
| Rate for Payer: United Healthcare All Payer |
$1,353.62
|
|
|
POLARUS PLUS ROD 8MM*200MM
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*200MM
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*220MM
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*220MM
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*240MM
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*240MM
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*260MM
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*260MM
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*280MM
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLARUS PLUS ROD 8MM*280MM
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
POLIBAR
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
25003891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.80 |
| 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 |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.84
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
POLIBAR
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
25003891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.80 |
| 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 |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.84
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
