|
PLATE POLYAX FEM 8141-31-115
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE POLYAX FEM 8141-31-115
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE POLYAX FEM 8141-31-118
|
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 8141-31-118
|
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 TIBIAL 11H LT
|
Facility
|
IP
|
$9,669.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.01 |
| Max. Negotiated Rate |
$9,282.53 |
| Rate for Payer: Aetna Commercial |
$7,445.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,542.05
|
| Rate for Payer: Cash Price |
$4,834.65
|
| Rate for Payer: Cigna Commercial |
$8,025.52
|
| Rate for Payer: First Health Commercial |
$9,185.84
|
| Rate for Payer: Humana Commercial |
$8,218.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,928.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,135.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,508.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.48
|
| Rate for Payer: PHCS Commercial |
$9,282.53
|
| Rate for Payer: United Healthcare All Payer |
$8,508.98
|
|
|
PLATE POLYAX TIBIAL 11H LT
|
Facility
|
OP
|
$9,669.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.01 |
| Max. Negotiated Rate |
$9,282.53 |
| Rate for Payer: Aetna Commercial |
$7,445.36
|
| Rate for Payer: Anthem Medicaid |
$3,325.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,542.05
|
| Rate for Payer: Cash Price |
$4,834.65
|
| Rate for Payer: Cigna Commercial |
$8,025.52
|
| Rate for Payer: First Health Commercial |
$9,185.84
|
| Rate for Payer: Humana Commercial |
$8,218.90
|
| Rate for Payer: Humana KY Medicaid |
$3,325.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,359.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,928.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,135.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,391.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,508.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.48
|
| Rate for Payer: PHCS Commercial |
$9,282.53
|
| Rate for Payer: United Healthcare All Payer |
$8,508.98
|
|
|
PLATE POLYAX TIBIAL 11H RT
|
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 TIBIAL 11H RT
|
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 TIBIAL 14H LT
|
Facility
|
IP
|
$9,669.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.01 |
| Max. Negotiated Rate |
$9,282.53 |
| Rate for Payer: Aetna Commercial |
$7,445.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,542.05
|
| Rate for Payer: Cash Price |
$4,834.65
|
| Rate for Payer: Cigna Commercial |
$8,025.52
|
| Rate for Payer: First Health Commercial |
$9,185.84
|
| Rate for Payer: Humana Commercial |
$8,218.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,928.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,135.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,508.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.48
|
| Rate for Payer: PHCS Commercial |
$9,282.53
|
| Rate for Payer: United Healthcare All Payer |
$8,508.98
|
|
|
PLATE POLYAX TIBIAL 14H LT
|
Facility
|
OP
|
$9,669.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.01 |
| Max. Negotiated Rate |
$9,282.53 |
| Rate for Payer: Aetna Commercial |
$7,445.36
|
| Rate for Payer: Anthem Medicaid |
$3,325.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,542.05
|
| Rate for Payer: Cash Price |
$4,834.65
|
| Rate for Payer: Cigna Commercial |
$8,025.52
|
| Rate for Payer: First Health Commercial |
$9,185.84
|
| Rate for Payer: Humana Commercial |
$8,218.90
|
| Rate for Payer: Humana KY Medicaid |
$3,325.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,359.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,928.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,135.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,391.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,508.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.48
|
| Rate for Payer: PHCS Commercial |
$9,282.53
|
| Rate for Payer: United Healthcare All Payer |
$8,508.98
|
|
|
PLATE POLYAX TIBIAL 2H LT
|
Facility
|
OP
|
$9,669.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.01 |
| Max. Negotiated Rate |
$9,282.53 |
| Rate for Payer: Anthem Medicaid |
$3,325.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,542.05
|
| Rate for Payer: Cash Price |
$4,834.65
|
| Rate for Payer: Cigna Commercial |
$8,025.52
|
| Rate for Payer: First Health Commercial |
$9,185.84
|
| Rate for Payer: Humana Commercial |
$8,218.90
|
| Rate for Payer: Humana KY Medicaid |
$3,325.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,359.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,928.83
|
| Rate for Payer: Aetna Commercial |
$7,445.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,135.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,391.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,508.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.48
|
| Rate for Payer: PHCS Commercial |
$9,282.53
|
| Rate for Payer: United Healthcare All Payer |
$8,508.98
|
|
|
PLATE POLYAX TIBIAL 2H LT
|
Facility
|
IP
|
$9,669.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.01 |
| Max. Negotiated Rate |
$9,282.53 |
| Rate for Payer: Aetna Commercial |
$7,445.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,542.05
|
| Rate for Payer: Cash Price |
$4,834.65
|
| Rate for Payer: Cigna Commercial |
$8,025.52
|
| Rate for Payer: First Health Commercial |
$9,185.84
|
| Rate for Payer: Humana Commercial |
$8,218.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,928.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,135.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,900.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,508.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,251.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,933.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.48
|
| Rate for Payer: PHCS Commercial |
$9,282.53
|
| Rate for Payer: United Healthcare All Payer |
$8,508.98
|
|
|
PLATE POLYAX TIBIAL 2H RT
|
Facility
|
IP
|
$8,913.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.79 |
| Max. Negotiated Rate |
$8,557.20 |
| Rate for Payer: Aetna Commercial |
$6,863.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.72
|
| Rate for Payer: Cash Price |
$4,456.88
|
| Rate for Payer: Cigna Commercial |
$7,398.41
|
| Rate for Payer: First Health Commercial |
$8,468.06
|
| Rate for Payer: Humana Commercial |
$7,576.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.26
|
| Rate for Payer: PHCS Commercial |
$8,557.20
|
| Rate for Payer: United Healthcare All Payer |
$7,844.10
|
|
|
PLATE POLYAX TIBIAL 2H RT
|
Facility
|
OP
|
$8,913.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.79 |
| Max. Negotiated Rate |
$8,557.20 |
| Rate for Payer: Aetna Commercial |
$6,863.59
|
| Rate for Payer: Anthem Medicaid |
$3,065.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.72
|
| Rate for Payer: Cash Price |
$4,456.88
|
| Rate for Payer: Cigna Commercial |
$7,398.41
|
| Rate for Payer: First Health Commercial |
$8,468.06
|
| Rate for Payer: Humana Commercial |
$7,576.69
|
| Rate for Payer: Humana KY Medicaid |
$3,065.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.26
|
| Rate for Payer: PHCS Commercial |
$8,557.20
|
| Rate for Payer: United Healthcare All Payer |
$7,844.10
|
|
|
PLATE POLYAX TIBIAL 5H LT
|
Facility
|
OP
|
$10,048.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.36 |
| Max. Negotiated Rate |
$9,646.94 |
| Rate for Payer: Aetna Commercial |
$7,737.65
|
| Rate for Payer: Anthem Medicaid |
$3,455.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,838.14
|
| Rate for Payer: Cash Price |
$5,024.45
|
| Rate for Payer: Cigna Commercial |
$8,340.59
|
| Rate for Payer: First Health Commercial |
$9,546.46
|
| Rate for Payer: Humana Commercial |
$8,541.56
|
| Rate for Payer: Humana KY Medicaid |
$3,455.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,240.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,416.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,525.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,843.03
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,009.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,306.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,115.16
|
| Rate for Payer: PHCS Commercial |
$9,646.94
|
| Rate for Payer: United Healthcare All Payer |
$8,843.03
|
|
|
PLATE POLYAX TIBIAL 5H LT
|
Facility
|
IP
|
$10,048.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.36 |
| Max. Negotiated Rate |
$9,646.94 |
| Rate for Payer: Aetna Commercial |
$7,737.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,838.14
|
| Rate for Payer: Cash Price |
$5,024.45
|
| Rate for Payer: Cigna Commercial |
$8,340.59
|
| Rate for Payer: First Health Commercial |
$9,546.46
|
| Rate for Payer: Humana Commercial |
$8,541.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,240.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,416.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,843.03
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,009.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,306.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,115.16
|
| Rate for Payer: PHCS Commercial |
$9,646.94
|
| Rate for Payer: United Healthcare All Payer |
$8,843.03
|
|
|
PLATE POLYAX TIBIAL 5H RT
|
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
|
|
|
PLATE POLYAX TIBIAL 5H RT
|
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 TIBIAL 8H RT
|
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 TIBIAL 8H RT
|
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 POSTEROLATERAL FIB 3H L
|
Facility
|
IP
|
$4,748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$4,558.08 |
| Rate for Payer: Aetna Commercial |
$3,655.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,703.44
|
| Rate for Payer: Cash Price |
$2,374.00
|
| Rate for Payer: Cigna Commercial |
$3,940.84
|
| Rate for Payer: First Health Commercial |
$4,510.60
|
| Rate for Payer: Humana Commercial |
$4,035.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,893.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,178.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.88
|
| Rate for Payer: PHCS Commercial |
$4,558.08
|
| Rate for Payer: United Healthcare All Payer |
$4,178.24
|
|
|
PLATE POSTEROLATERAL FIB 3H L
|
Facility
|
OP
|
$4,748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$4,558.08 |
| Rate for Payer: Anthem Medicaid |
$1,632.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,703.44
|
| Rate for Payer: Cash Price |
$2,374.00
|
| Rate for Payer: Cigna Commercial |
$3,940.84
|
| Rate for Payer: First Health Commercial |
$4,510.60
|
| Rate for Payer: Humana Commercial |
$4,035.80
|
| Rate for Payer: Humana KY Medicaid |
$1,632.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,893.36
|
| Rate for Payer: Aetna Commercial |
$3,655.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,178.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.88
|
| Rate for Payer: PHCS Commercial |
$4,558.08
|
| Rate for Payer: United Healthcare All Payer |
$4,178.24
|
|
|
PLATE POSTEROLATERAL FIB 3H R
|
Facility
|
OP
|
$4,748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$4,558.08 |
| Rate for Payer: Aetna Commercial |
$3,655.96
|
| Rate for Payer: Anthem Medicaid |
$1,632.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,703.44
|
| Rate for Payer: Cash Price |
$2,374.00
|
| Rate for Payer: Cigna Commercial |
$3,940.84
|
| Rate for Payer: First Health Commercial |
$4,510.60
|
| Rate for Payer: Humana Commercial |
$4,035.80
|
| Rate for Payer: Humana KY Medicaid |
$1,632.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,893.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,178.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.88
|
| Rate for Payer: PHCS Commercial |
$4,558.08
|
| Rate for Payer: United Healthcare All Payer |
$4,178.24
|
|
|
PLATE POSTEROLATERAL FIB 3H R
|
Facility
|
IP
|
$4,748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$4,558.08 |
| Rate for Payer: Aetna Commercial |
$3,655.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,703.44
|
| Rate for Payer: Cash Price |
$2,374.00
|
| Rate for Payer: Cigna Commercial |
$3,940.84
|
| Rate for Payer: First Health Commercial |
$4,510.60
|
| Rate for Payer: Humana Commercial |
$4,035.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,893.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,178.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.88
|
| Rate for Payer: PHCS Commercial |
$4,558.08
|
| Rate for Payer: United Healthcare All Payer |
$4,178.24
|
|
|
PLATE POSTEROLATERAL FIB 4H L
|
Facility
|
IP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
