|
PLATE POLARUS 3 STD 22H 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 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 STD 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 STD 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 STD 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 STD 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: 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 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 STD 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 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 POLYAX FEM 8141-30-106
|
Facility
|
IP
|
$7,597.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.73 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$5,850.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.38
|
| Rate for Payer: Cash Price |
$3,798.96
|
| Rate for Payer: Cigna Commercial |
$6,306.27
|
| Rate for Payer: First Health Commercial |
$7,218.02
|
| Rate for Payer: Humana Commercial |
$6,458.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.36
|
| Rate for Payer: PHCS Commercial |
$7,294.00
|
| Rate for Payer: United Healthcare All Payer |
$6,686.17
|
|
|
PLATE POLYAX FEM 8141-30-106
|
Facility
|
OP
|
$7,597.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.73 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$5,850.40
|
| Rate for Payer: Anthem Medicaid |
$2,612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.38
|
| Rate for Payer: Cash Price |
$3,798.96
|
| Rate for Payer: Cigna Commercial |
$6,306.27
|
| Rate for Payer: First Health Commercial |
$7,218.02
|
| Rate for Payer: Humana Commercial |
$6,458.23
|
| Rate for Payer: Humana KY Medicaid |
$2,612.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,639.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.36
|
| Rate for Payer: PHCS Commercial |
$7,294.00
|
| Rate for Payer: United Healthcare All Payer |
$6,686.17
|
|
|
PLATE POLYAX FEM 8141-30-109
|
Facility
|
IP
|
$9,280.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.48 |
| Max. Negotiated Rate |
$8,909.36 |
| Rate for Payer: Aetna Commercial |
$7,146.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,238.85
|
| Rate for Payer: Cash Price |
$4,640.29
|
| Rate for Payer: Cigna Commercial |
$7,702.88
|
| Rate for Payer: First Health Commercial |
$8,816.55
|
| Rate for Payer: Humana Commercial |
$7,888.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,849.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,784.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,166.91
|
| Rate for Payer: Ohio Health Group HMO |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.98
|
| Rate for Payer: PHCS Commercial |
$8,909.36
|
| Rate for Payer: United Healthcare All Payer |
$8,166.91
|
|
|
PLATE POLYAX FEM 8141-30-109
|
Facility
|
OP
|
$9,280.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.48 |
| Max. Negotiated Rate |
$8,909.36 |
| Rate for Payer: Aetna Commercial |
$7,146.05
|
| Rate for Payer: Anthem Medicaid |
$3,191.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,238.85
|
| Rate for Payer: Cash Price |
$4,640.29
|
| Rate for Payer: Cigna Commercial |
$7,702.88
|
| Rate for Payer: First Health Commercial |
$8,816.55
|
| Rate for Payer: Humana Commercial |
$7,888.49
|
| Rate for Payer: Humana KY Medicaid |
$3,191.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,849.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,784.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,255.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,166.91
|
| Rate for Payer: Ohio Health Group HMO |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.98
|
| Rate for Payer: PHCS Commercial |
$8,909.36
|
| Rate for Payer: United Healthcare All Payer |
$8,166.91
|
|
|
PLATE POLYAX FEM 8141-30-112
|
Facility
|
IP
|
$9,280.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.48 |
| Max. Negotiated Rate |
$8,909.36 |
| Rate for Payer: Aetna Commercial |
$7,146.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,238.85
|
| Rate for Payer: Cash Price |
$4,640.29
|
| Rate for Payer: Cigna Commercial |
$7,702.88
|
| Rate for Payer: First Health Commercial |
$8,816.55
|
| Rate for Payer: Humana Commercial |
$7,888.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,849.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,784.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,166.91
|
| Rate for Payer: Ohio Health Group HMO |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.98
|
| Rate for Payer: PHCS Commercial |
$8,909.36
|
| Rate for Payer: United Healthcare All Payer |
$8,166.91
|
|
|
PLATE POLYAX FEM 8141-30-112
|
Facility
|
OP
|
$9,280.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.48 |
| Max. Negotiated Rate |
$8,909.36 |
| Rate for Payer: Aetna Commercial |
$7,146.05
|
| Rate for Payer: Anthem Medicaid |
$3,191.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,238.85
|
| Rate for Payer: Cash Price |
$4,640.29
|
| Rate for Payer: Cigna Commercial |
$7,702.88
|
| Rate for Payer: First Health Commercial |
$8,816.55
|
| Rate for Payer: Humana Commercial |
$7,888.49
|
| Rate for Payer: Humana KY Medicaid |
$3,191.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,849.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,784.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,255.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,166.91
|
| Rate for Payer: Ohio Health Group HMO |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.98
|
| Rate for Payer: PHCS Commercial |
$8,909.36
|
| Rate for Payer: United Healthcare All Payer |
$8,166.91
|
|
|
PLATE POLYAX FEM 8141-30-115
|
Facility
|
IP
|
$10,866.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,412.64 |
| Max. Negotiated Rate |
$10,431.79 |
| Rate for Payer: Aetna Commercial |
$8,367.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,475.83
|
| Rate for Payer: Cash Price |
$5,433.23
|
| Rate for Payer: Cigna Commercial |
$9,019.15
|
| Rate for Payer: First Health Commercial |
$10,323.13
|
| Rate for Payer: Humana Commercial |
$9,236.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,910.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,019.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,562.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,149.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,173.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,412.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.60
|
| Rate for Payer: PHCS Commercial |
$10,431.79
|
| Rate for Payer: United Healthcare All Payer |
$9,562.48
|
|
|
PLATE POLYAX FEM 8141-30-115
|
Facility
|
OP
|
$10,866.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,412.64 |
| Max. Negotiated Rate |
$10,431.79 |
| Rate for Payer: Anthem Medicaid |
$3,736.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,475.83
|
| Rate for Payer: Cash Price |
$5,433.23
|
| Rate for Payer: Cigna Commercial |
$9,019.15
|
| Rate for Payer: First Health Commercial |
$10,323.13
|
| Rate for Payer: Humana Commercial |
$9,236.48
|
| Rate for Payer: Humana KY Medicaid |
$3,736.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,775.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,910.49
|
| Rate for Payer: Aetna Commercial |
$8,367.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,019.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,562.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,149.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,173.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,412.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.60
|
| Rate for Payer: PHCS Commercial |
$10,431.79
|
| Rate for Payer: United Healthcare All Payer |
$9,562.48
|
|
|
PLATE POLYAX FEM 8141-30-118
|
Facility
|
IP
|
$7,597.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.73 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$5,850.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.38
|
| Rate for Payer: Cash Price |
$3,798.96
|
| Rate for Payer: Cigna Commercial |
$6,306.27
|
| Rate for Payer: First Health Commercial |
$7,218.02
|
| Rate for Payer: Humana Commercial |
$6,458.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.36
|
| Rate for Payer: PHCS Commercial |
$7,294.00
|
| Rate for Payer: United Healthcare All Payer |
$6,686.17
|
|
|
PLATE POLYAX FEM 8141-30-118
|
Facility
|
OP
|
$7,597.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.73 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$5,850.40
|
| Rate for Payer: Anthem Medicaid |
$2,612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.38
|
| Rate for Payer: Cash Price |
$3,798.96
|
| Rate for Payer: Cigna Commercial |
$6,306.27
|
| Rate for Payer: First Health Commercial |
$7,218.02
|
| Rate for Payer: Humana Commercial |
$6,458.23
|
| Rate for Payer: Humana KY Medicaid |
$2,612.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,639.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.36
|
| Rate for Payer: PHCS Commercial |
$7,294.00
|
| Rate for Payer: United Healthcare All Payer |
$6,686.17
|
|
|
PLATE POLYAX FEM 8141-31-106
|
Facility
|
OP
|
$7,597.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.73 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$5,850.40
|
| Rate for Payer: Anthem Medicaid |
$2,612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.38
|
| Rate for Payer: Cash Price |
$3,798.96
|
| Rate for Payer: Cigna Commercial |
$6,306.27
|
| Rate for Payer: First Health Commercial |
$7,218.02
|
| Rate for Payer: Humana Commercial |
$6,458.23
|
| Rate for Payer: Humana KY Medicaid |
$2,612.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,639.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.36
|
| Rate for Payer: PHCS Commercial |
$7,294.00
|
| Rate for Payer: United Healthcare All Payer |
$6,686.17
|
|
|
PLATE POLYAX FEM 8141-31-106
|
Facility
|
IP
|
$7,597.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.73 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$5,850.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.38
|
| Rate for Payer: Cash Price |
$3,798.96
|
| Rate for Payer: Cigna Commercial |
$6,306.27
|
| Rate for Payer: First Health Commercial |
$7,218.02
|
| Rate for Payer: Humana Commercial |
$6,458.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.36
|
| Rate for Payer: PHCS Commercial |
$7,294.00
|
| Rate for Payer: United Healthcare All Payer |
$6,686.17
|
|
|
PLATE POLYAX FEM 8141-31-109
|
Facility
|
IP
|
$9,280.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.48 |
| Max. Negotiated Rate |
$8,909.36 |
| Rate for Payer: Aetna Commercial |
$7,146.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,238.85
|
| Rate for Payer: Cash Price |
$4,640.29
|
| Rate for Payer: Cigna Commercial |
$7,702.88
|
| Rate for Payer: First Health Commercial |
$8,816.55
|
| Rate for Payer: Humana Commercial |
$7,888.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,849.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,784.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,166.91
|
| Rate for Payer: Ohio Health Group HMO |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.98
|
| Rate for Payer: PHCS Commercial |
$8,909.36
|
| Rate for Payer: United Healthcare All Payer |
$8,166.91
|
|
|
PLATE POLYAX FEM 8141-31-109
|
Facility
|
OP
|
$9,280.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.48 |
| Max. Negotiated Rate |
$8,909.36 |
| Rate for Payer: Aetna Commercial |
$7,146.05
|
| Rate for Payer: Anthem Medicaid |
$3,191.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,238.85
|
| Rate for Payer: Cash Price |
$4,640.29
|
| Rate for Payer: Cigna Commercial |
$7,702.88
|
| Rate for Payer: First Health Commercial |
$8,816.55
|
| Rate for Payer: Humana Commercial |
$7,888.49
|
| Rate for Payer: Humana KY Medicaid |
$3,191.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,849.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,784.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,255.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,166.91
|
| Rate for Payer: Ohio Health Group HMO |
$6,960.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,206.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,876.98
|
| Rate for Payer: PHCS Commercial |
$8,909.36
|
| Rate for Payer: United Healthcare All Payer |
$8,166.91
|
|
|
PLATE POLYAX FEM 8141-31-112
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
PLATE POLYAX FEM 8141-31-112
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
