|
PLATE P-L-D HUM LK 9 132MM R
|
Facility
|
OP
|
$7,621.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.74 |
| Max. Negotiated Rate |
$7,316.26 |
| Rate for Payer: Anthem Medicaid |
$2,620.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,944.46
|
| Rate for Payer: Cash Price |
$3,810.55
|
| Rate for Payer: Cigna Commercial |
$6,325.51
|
| Rate for Payer: First Health Commercial |
$7,240.04
|
| Rate for Payer: Humana Commercial |
$6,477.94
|
| Rate for Payer: Humana KY Medicaid |
$2,620.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,647.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,249.30
|
| Rate for Payer: Aetna Commercial |
$5,868.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,624.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,673.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,706.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,715.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,362.54
|
| Rate for Payer: PHCS Commercial |
$7,316.26
|
| Rate for Payer: United Healthcare All Payer |
$6,706.57
|
|
|
PLATE P-L-D HUM LK 9 132MM R
|
Facility
|
IP
|
$7,621.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.74 |
| Max. Negotiated Rate |
$7,316.26 |
| Rate for Payer: Aetna Commercial |
$5,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,944.46
|
| Rate for Payer: Cash Price |
$3,810.55
|
| Rate for Payer: Cigna Commercial |
$6,325.51
|
| Rate for Payer: First Health Commercial |
$7,240.04
|
| Rate for Payer: Humana Commercial |
$6,477.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,249.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,624.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,706.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,715.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,362.54
|
| Rate for Payer: PHCS Commercial |
$7,316.26
|
| Rate for Payer: United Healthcare All Payer |
$6,706.57
|
|
|
PLATE POLARUS 3 POST 4H L
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 POST 4H L
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 POST 4H R
|
Facility
|
IP
|
$7,136.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.71 |
| Max. Negotiated Rate |
$6,850.75 |
| Rate for Payer: Aetna Commercial |
$5,494.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,566.24
|
| Rate for Payer: Cash Price |
$3,568.10
|
| Rate for Payer: Cigna Commercial |
$5,923.05
|
| Rate for Payer: First Health Commercial |
$6,779.39
|
| Rate for Payer: Humana Commercial |
$6,065.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,851.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,266.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,279.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,352.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,427.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.22
|
| Rate for Payer: PHCS Commercial |
$6,850.75
|
| Rate for Payer: United Healthcare All Payer |
$6,279.86
|
|
|
PLATE POLARUS 3 POST 4H R
|
Facility
|
OP
|
$7,136.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.71 |
| Max. Negotiated Rate |
$6,850.75 |
| Rate for Payer: Aetna Commercial |
$5,494.87
|
| Rate for Payer: Anthem Medicaid |
$2,454.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,566.24
|
| Rate for Payer: Cash Price |
$3,568.10
|
| Rate for Payer: Cigna Commercial |
$5,923.05
|
| Rate for Payer: First Health Commercial |
$6,779.39
|
| Rate for Payer: Humana Commercial |
$6,065.77
|
| Rate for Payer: Humana KY Medicaid |
$2,454.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,479.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,851.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,266.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,503.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,279.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,352.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,427.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.22
|
| Rate for Payer: PHCS Commercial |
$6,850.75
|
| Rate for Payer: United Healthcare All Payer |
$6,279.86
|
|
|
PLATE POLARUS 3 POST 6H L
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 POST 6H L
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 POST 6H R
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 POST 6H R
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 10H L
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 10H L
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 10H R
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 10H R
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 14H L
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 14H L
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 14H R
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 14H R
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 18H L
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 18H L
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 18H R
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 18H R
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 22H L
|
Facility
|
IP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 22H L
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
|
PLATE POLARUS 3 STD 22H R
|
Facility
|
OP
|
$6,789.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.63 |
| Max. Negotiated Rate |
$6,517.87 |
| Rate for Payer: Aetna Commercial |
$5,227.88
|
| Rate for Payer: Anthem Medicaid |
$2,334.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.77
|
| Rate for Payer: Cash Price |
$3,394.72
|
| Rate for Payer: Cigna Commercial |
$5,635.24
|
| Rate for Payer: First Health Commercial |
$6,449.98
|
| Rate for Payer: Humana Commercial |
$5,771.03
|
| Rate for Payer: Humana KY Medicaid |
$2,334.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,567.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,092.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.73
|
| Rate for Payer: PHCS Commercial |
$6,517.87
|
| Rate for Payer: United Healthcare All Payer |
$5,974.72
|
|
